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1
Saravanan, Palaniappan. "Effect of omega-3 fatty acids on atrial fibrillation following coronary artery bypass surgery and cardiac calcium handling in humans". Thesis, University of Manchester, 2011. https://www.research.manchester.ac.uk/portal/en/theses/effect-of-omega3-fatty-acids-on-atrial-fibrillation-following-coronary-artery-bypass-surgery-and-cardiac-calcium-handling-in-humans(660e7236-f91d-4512-b3a4-822360b02378).html.
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Omega 3 poly unsaturated fatty acids (n-3 PUFA) have been shown to protect against sudden cardiac death following myocardial infarction and reduce the risk of ventricular arrhythmias in patients with heart failure. At the inception of this study, there was one clinical study that reported n-3 PUFA supplementation reduced the risk of atrial fibrillation (AF) following CABG. As AF is a very common arrhythmia and as there are no safe and effective means of preventing AF, we designed this study to further validate the findings of the previous study in a more robust study design. In addition, this study also aimed to evaluate the cellular changes that underpin the beneficial anti-arrhythmic effect of n-3 PUFA.The outcome of this study shows that n-3 PUFA does not reduce the risk of AF following CABG. However, short term supplementation with n-3 PUFA reliably increases the membrane incorporation in phospholipids and results in alteration in the expression levels of cardiac calcium handling proteins phospholamban and ryanodine receptors. In addition, such incorporation in animal (rat) ventricular myocytes leads to changes in the rate of decay of the systolic calcium transient and an increase in the amplitude of the caffeine induced calcium transient thereby indicating a greater activity of SERCA. These findings needs further evaluation but is clearly interesting as the clinical situations where n-3 PUFA have been shown to be anti-arrhythmic are situations where cellular calcium overload is the main mechanism of arrhythmogenesis.
2
Maynard, Charles. "Blacks in the coronary artery surgery study /". Thesis, Connect to this title online; UW restricted, 1986. http://hdl.handle.net/1773/8877.
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Vedin, Jenny. "Coronary artery bypass surgery without extracorporeal circulation /". Stockholm, 2005. http://diss.kib.ki.se/2006/91-7140-507-0/.
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Groom, Christina Sophia. "Functional outcomes after coronary artery bypass surgery". Thesis, University of Liverpool, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.494159.
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Cardiopulmonary Bypass (CPB) isolates the heart from the circulatory system. As a result, Coronary Artery Bypass Graft (CABG) surgery has become a common treatment for coronary artery disease (CAD) relieving angina and improving health related quality of life (HRQOL) and mood. However, CABG has been associated with Central Nervous System (CNS) dysfunction and successful surgery can be marred by cognitive impairment and/or poor HRQOL/ mood.
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Lim, Eric Kian Saik. "Optimum aspirin therapy for coronary artery bypass surgery". Thesis, University of East Anglia, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.435058.
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Riedel, Bernard J. C. J. "Epidural analgesia for coronary artery bypass graft surgery". Master's thesis, University of Cape Town, 1999. http://hdl.handle.net/11427/25890.
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On reviewing the medical literature, there is a clear resurgence of interest in the use of TEA (thoracic epidural analgesic) in cardiac anaesthesia. This resurgence was brought about by laboratory-based evidence that TEA-induced sympatholysis may be cardioprotective through the promotion of myocardial blood flow to areas at-risk and subsequent early, small clinical studies suggesting that TEA was feasible, and possibly also beneficial in CABG surgery [Joachimsson et. al, 1989; Liem (1-3) et. al, 1992; Stenseth et. al, 1994]. Despite the positive results of these early studies and suggestions that TEA may be the preferred anaesthetic/analgesic technique in select groups of patients (promoting early extubation and fast-tracking) undergoing cardiac surgery, many anaesthetists are still reluctant, however, to use this technique because of the theoretical increased risk of the patient suffering a spinal haematoma and subsequent paraplegia. In order to outweigh this theoretical risk it is important that we show that added benefit, in addition to the provision of analgesia and expedited postoperative convalescence, can be obtained by using TEA. It is therefore our duty as anaesthetists and perioperative physicians to determine whether TEA may also affect the pathophysiology of the disease process, especially in the perioperative period - and thereby influencing the subsequent long term outcome and quality of life of the patient. An example of this latter point would be the potential role of TEA in; • reducing the incidence of perioperative myocardial infarction (P-MI), through the suggested cardioprotective effects of TEA, • reducing the incidence of early postoperative graft failure, through either; * reduction of native coronary artery and/or graft (conduit) spasm, or * reduction of postoperative hypercoagulability.
7
Poon, Chui-yuk Mabel. "The patients lived experiences after coronary artery bypass graft surgery /". View the Table of Contents & Abstract, 2005. http://sunzi.lib.hku.hk/hkuto/record/B31596071.
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Lee, Chi-hang y 李志恆. "Microvascular obstruction following percutaneous coronary interventionfor coronary artery disease". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2009. http://hub.hku.hk/bib/B43278723.
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Ruengsakulrach, Permyos. "Safety and efficacy of radial artery conduits for coronary artery bypass surgery /". Connect to thesis, 2001. http://eprints.unimelb.edu.au/archive/00000243.
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Ofoegbu, Chimu K. P. "Outcomes of "off-pump" coronary artery bypass grafting in a developing country : advantages over coronary artery bypass grafting on cardiopulmonary bypass". Master's thesis, University of Cape Town, 2010. http://hdl.handle.net/11427/11432.
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Includes abstract.Includes bibliographic references (leaves 53-62).
Off-pump coronary artery bypass grafting (OPCAB) was developed to avoid the deleterious effects of CPB. Current literature reveals some peri-operative advantages of OPCAB, with few studies detailing these in Africa. We review our institutional experience with both approaches in higher risk patients to determine pre-operative characteristics, short and mid-term outcomes in a developing country.
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Lim, Richard. "Prognostic assessment of coronary artery disease by first-pass radionuclide ventriculography". Thesis, University of Newcastle Upon Tyne, 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.357672.
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Alström, Ulrica. "Platelet Inhibition and Bleeding in Coronary Artery Bypass Surgery". Doctoral thesis, Uppsala universitet, Institutionen för kirurgiska vetenskaper, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-146458.
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A substantial number of patients undergoing cardiac surgery are on dual anti-platelet treatment with clopidogrel and aspirin. A disadvantage with this treatment is increased risk of bleeding. Bleeding is a complication of major concern associated with adverse outcome for the patient and increased hospital resource utilization. Great variability in individual response to clopidogrel has been reported. If in vitro measurements of platelet reactivity would correlate with clinical bleeding parameters, potential bleeders could be identified preoperatively. The aims of this thesis were: (1) to describe the degree of pre-operative platelet inhibition in patients scheduled for primary isolated coronary artery bypass graft surgery; (2) to prospectively investigate whether the pre-operative platelet inhibition correlated with intra- and postoperative bleeding and transfusion requirements; and (3) to test the ability of clinically relevant risk factors to predict re-exploration for bleeding. (4) In addition, a cost analysis was performed on patients re-explored for bleeding, to analyse the magnitude of added resource utilization and costs. Based on this, a cost model of prophylactic treatment with haemostatic drugs was calculated. Platelet function tests investigated were: (1) flow cytometry, (2) VASP, (3) VerifyNowSystem, (4) PlateletMapping (a modified TEG), and (5) PFA-100. Clinical risk factors for re-exploration and the influence of antiplatelet and antifibrinolytic therapy were evaluated in a retrospective analysis. Cost analysis at three cardiothoracic centres was performed in a case-control study. In conclusion, there was no clinically useful correlation between preoperative assessment of platelet inhibition and blood loss or transfusion requirements during coronary artery bypass surgery. Furthermore, there was only modest agreement between the methods evaluating ADP-receptor blockade. Pre-operative treatment with the P2Y12-receptor inhibitor clopidogrel was an essential risk factor for re-exploration due to bleeding. Except for clopidogrel, no strong clinical factor to predict the risk of re-exploration was identified. The resource utilisation costs were 47% higher in patients requiring re-exploration due to bleeding than in those not requiring re-exploration. Prolonged stay in the ICU and recovery ward accounted for half of the added cost, a third was due to the costs of surgery, one fifth due to increased cost of transfusions, and <2% was due to haemostatic drug treatment.
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Lahtinen, J. (Jarmo). "Predictors of immediate outcome after coronary artery bypass surgery". Doctoral thesis, University of Oulu, 2007. http://urn.fi/urn:isbn:9789514286339.
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Abstract
The identification of risk factors for major adverse events after coronary artery bypass surgery is of main importance as it allows outcome prediction, facilitates preoperative patient selection and improves the quality of care. In the present clinical studies we have evaluated the impact of preoperative angiographic severity of a coronary artery disease and preoperative C-reactive protein (CRP) on the immediate outcome after coronary artery bypass surgery. We have reviewed the results of off-pump (OPCAB) versus conventional on-pump coronary artery bypass surgery (CCAB) in high risk patients. We have evaluated the impact of postoperative pulmonary artery blood temperature on the immediate outcome as well. In addition, we have investigated the incidence, timing and outcome of an atrial fibrillation (AF) related stroke after surgery.
The multivariate analysis showed that among 2233 patients, the overall coronary angiographic score was predictive of postoperative death (p = 0.03; OR 1.027, 95% CI: 1.003–1.052) and of a low cardiac output syndrome (p = 0.04; OR 1.172, 95% CI: 1.010–1.218). The poor status of the proximal segment of the left circumflex coronary artery, the diagonal branches and the left obtuse marginal artery were most closely associated with adverse postoperative outcome.
Patients (114/764) with a preoperative serum concentration of CRP ≥ 1.0 mg/dL had a higher risk of overall postoperative death (5.3% vs. 1.1%, p = 0.001), cardiac death (4.4% vs. 0.8%, p = 0.002), a low cardiac output syndrome (8.8% vs. 3.7%, p = 0.01).
Among 179 high risk patients with an additive EuroSCORE6, the 30-day postoperative death and stroke rates were 7.5% and 6.0% in the OPCAB group, and 5.4% (p = 0.75) and 8.0% (p = 0.77) in the CCAB group, respectively. No significant differences were observed in other major outcome end-points between these non-randomised groups either.
High pulmonary artery blood temperature on admission to the ICU among 1639 patients was significantly associated with an increased risk of overall postoperative death (p = 0.002), cardiac death (p = 0.03), and a low cardiac output syndrome (p < 0.0001), and was significantly correlated with prolonged length of the ICU stay (r = 0.095; p < 0.0001), and postoperative bleeding (ρ = –0.091; p = 0.001).
Among 2,630 patients who underwent coronary artery bypass grafting (CABG), 52 (2.0%) experienced a postoperative stroke. Twelve out of these 52 patients (23.1%) died postoperatively. The ischemic cerebral event occurred after a mean of 3.7 days (0–33). In 19 patients (36.5%), atrial fibrillation preceded the occurrence of neurological complication.
The angiographic severity of the coronary artery disease and the preoperative serum concentration of CRP predict postoperative outcome after a CABG operation. OPCAB can be performed safely in high-risk patients with results as satisfactory as those achieved with CCAB. CABG patients with a high pulmonary artery blood temperature on admission to the ICU seem to have a higher risk of postoperative adverse events. Atrial fibrillation occurring after coronary artery bypass grafting is a major determinant of a postoperative stroke.
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Okrainec, Karen. "Cardiac medical therapy following coronary artery bypass graft surgery". Thesis, McGill University, 2003. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=80344.
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Despite the benefits of coronary artery bypass graft surgery (CABG), graft closure can still occur and lead to the development of unstable angina, myocardial infarction (MI) and death. Secondary prevention is thus greatly needed in order to prevent future cardiovascular events in the post-CABG patient. Few studies have examined the benefits of cardiac medical therapy specifically among CABG patients. A review of randomized controlled trials (RCT's) was first conducted in order to understand what constitutes appropriate cardiac medical therapy in the post-CABG patient.The use of aspirin, clopidogrel, coumadin, anti-lipid agents, anti-ischemic medications (beta-blockers, CCB's, nitrates) and ACE inhibitors was then examined among patients enrolled in the Routine versus Selective Exercise Treadmill Testing After Coronary Artery Bypass Graft Surgery (ROSETTA-CABG) Study. We examined the use of these medications among all patients as well as patients with various co-morbidities.
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Dunckley, Maria. "Barriers to recovery after coronary artery bypass grafting surgery". Thesis, Coventry University, 2007. http://curve.coventry.ac.uk/open/items/cb90ef80-269b-6eb1-2986-bb2c61227bb3/1.
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Introduction: Coronary artery bypass grafting surgery is an effective treatment for coronary heart disease for many patients; however, evidence suggests that there are some patients who do not report a good post-operative recovery. Although several studies have begun investigating possible reasons for these observations, little is known about the impact of CABG on quality of life and there still remains a lack of information that can help clinicians identify those people more likely to experience poorer recovery so that interventions can be targeted appropriately. Aims: The overall aim was to investigate barriers to and facilitators of recovery after CABG. Method: Phase 1 was a retrospective qualitative study involving semi-structured interviews with eleven patients who had undergone CABG and with ten health professionals experienced in caring for these patients. Data were analysed using thematic analysis. Phase 2 was a prospective study comprising two components, questionnaire and interview. The questionnaire included measures of quality of life, perceived recovery, demographic and psychosocial variables and was administered prior to surgery and at six and twelve months post-surgery. A sample of ten people who completed questionnaires were interviewed at the same time points and data analysed using framework analysis. Results: Interview data described the patient experience of undergoing CABG and identified components of a good recovery from the patient perspective. Patient and health professional participants identified numerous barriers and facilitators to recovery at three key time points - prior to surgery, during the hospital inpatient stay and post-CABG - and noted the complex inter-relationships between them, thus emphasising the need for a holistic approach to investigating recovery. Questionnaire data described the pattern of psychosocial functioning, quality of life and perceived recovery across the surgical pathway and identified depression and self-efficacy as the main predictors of post-CABG quality of life and perceived recovery. Using interview and questionnaire data a model of recovery is proposed. Conclusions: Findings from this research have identified a complex inter-related network of barriers and facilitators to recovery, suggested the possible mechanisms by which they impact on post-CABG outcome and identified recommendations for clinical practice.
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Strickler, Amy Ann. "Functional Capacity Outcomes following Coronary Artery Bypass Graft Surgery". Thesis, Virginia Tech, 1998. http://hdl.handle.net/10919/36680.
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The objective of this study was to determine if this is possible to predict 3 mo post-CABG treadmill VO2pk outcomes from a combination of pre-surgical physical fitness and health and clinical status variables. To determine the VO2pk, subjects performed a maximal treadmill test using a ramp protocol and gas analysis. When all pre-surgical variables where included in a multiple linear regression, the analysis yielded a model that included the prior to surgery VSAQ, orthopedic limitations, and angiotensin converting enzymes (ACE) inhibitor drugs as significant predictors (R2 = 0.50, N = 63). When an RER of 1.1 was achieved during the treadmill test, myocardial infarction (MI) and if so, the length of time lapse from the MI, chronic heart failure, lipid lowering drugs, BMI, ACE inhibitor drugs, and orthopedic limitations (R2 = 0.56, N =29) were significant predictors. The data suggest that there is some relationship between post-surgical outcomes and pre-surgical physical fitness.Master of Science
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Theobald, Karen. "Influences on Post-Discharge Recovery Following Coronary Artery Bypass Graft Surgery". Thesis, Griffith University, 2001. http://hdl.handle.net/10072/367398.
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Many things change following Coronary Artery Bypass Graft (CABG) surgery for both the patient and his/her carer. The major aim of this research was to provide an indepth examination of these changes to investigate influences on recovery. The study was devised on the premise that this information would provide a significant basis for hospital discharge planning.
A qualitative research approach, naturalistic inquiry, guided the study. Sixty people were interviewed, including thirty patients and their carers. Interviews were undertaken four to five weeks following discharge from hospital after CABG surgery. Subsequently, twelve months after the initial interview, patients and carers were again contacted to verify the findings generated from the first phase of the study, and to gain further data on his/her current health status.
Data analysis revealed a number of maj or themes and sub themes for patients and carers. Almost half the patients stated that heart surgery was a huge personal shock. Adjusting to life after surgery was difficult, and patients experienced some form of physical pain or change. An unexpected finding was the extent to which many of the patients were attuned to their post-operative physical adjustments. They spoke of mental and emotional changes as well as concerns over the financial burden of the surgery. Coming to terms with lifestyle adjustments and worrying about the future were other themes that emerged in patients’ accounts. They offered suggestions to improve support services, like establishing a twenty-four hour telephone chat line and forming community clubs to link up with other patients. In assisting to better prepare for discharge home, they suggested providing more information about what to expect during recovery, like the up and down days that they might experience.
Carers experienced a separate set of issues/needs and concerns as they came to terms with their loved one’s cardiac surgical recovery. The major findings for carers fell under four major themes, Events Surrounding Another’s Heart Surgery; Adjusting to the Surgery; Personal Changes Due to Surgery and Discovering Pathways to Recovery. Carers were shocked with the news that a family member required urgent cardiac surgery and theft reactions suggested a sequence of experiences that encountered in coming to terms with the event. Carers adjusted to the situation by taking on the role of watcher or minder and monitored the patient’s recovery. Some of the personal changes that carers dealt with, were changes in their activities and responsibilities; tiredness; experiencing a range of emotions and wonying about the unknown. Carers also offered suggestions for improved support services, like identifying a range of community services in close locality to his/her home. In better preparing for discharge home, some carers wanted more assistance and advice on how to be an effective carer.
This research study provides unique insights into the experiences of patients and carers after coronary bypass graft surgery in the first four to five weeks following discharge home from hospital. The study outlines the issues/concerns and needs of CABG patients and their carers after they leave hospital, highlighting those related to age, gender, and family support. For example, many patients commented that they were too young for this to occur. Gender differences included, that the majority of carers were females and male patients reported experiencing more pain following cardiac surgery. Family support was a critical factor in enhancing recovery. Study findings suggest the need for a re-examination of hospital discharge preparation and the further provision and monitoring of home support services.Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Nursing
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Penttilä, H. (Hannu). "Myocardial and cerebral preservation during off-pump coronary artery surgery". Doctoral thesis, University of Oulu, 2006. http://urn.fi/urn:isbn:9514279735.
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Abstract
Interest in off-pump coronary surgery and ischaemic preconditioning has been increasing. The aim of this study was to evaluate surrogate indicators of haemodynamic, myocardial, and cerebral outcome during off-pump surgery and preconditioning.
Haemodynamics and myocardial preservation were monitored in a pilot study of twelve patients undergoing off-pump coronary surgery. Indicators of myocardial metabolism and tissue injury as well as cerebral damage were evaluated in a randomized study of thirty-three patients undergoing on-pump (11) or off-pump surgery with (11) or without (11) preceding myocardial ischaemic preconditioning for five minutes followed by reperfusion for five minutes.
The pilot study showed minimal haemodynamic changes and myocardial derangements during off-pump surgery as evaluated intraoperatively based on transcardiac differences of ATP degradation products and lactate and postoperatively based on MB mass of creatine kinase and troponin T.
In the following studies, myocardial ischaemic metabolism was evaluated intraoperatively by measuring transcardiac differences of ATP degradation products, lactate, and pH, which increased significantly from the baseline values in all study groups. However, the maximum values of lactate and pH were significantly higher in the cardiopulmonary bypass group (p = 0.02 and p = 0.007, respectively). There were no statistical differences between the preconditioning and non-preconditioning groups. Myocardial tissue injury was evaluated by postoperative leakage of MB mass of creatine kinase and troponin I. Their peak values were significantly higher (p < 0.001 and p = 0.008) after cardiopulmonary bypass (15.1 μg/l and 13.8 μg/l) than after off-pump surgery without preconditioning (6.3 μg/l and 5.2 μg/l). The respective values were 14.8 μg/l and 7.4 μg/l after preconditioning, and there were no statistically significant differences between the off-pump groups with and without preconditioning. Cerebral damage was evaluated based on the intra- and postoperative serum concentrations of neuron-specific enolase, which were corrected with respect to haemolysis. The corrected values were significantly higher after on-pump than off-pump surgery (p = 0.003 and p = 0.005).
In conclusion, multi-vessel off-pump coronary artery surgery is a haemodynamically feasible procedure offering better myocardial preservation compared to on-pump surgery. Ischaemic preconditioning of the myocardium does not seem to improve myocardial preservation in off-pump surgery. The slightly lower levels of neuron-specific enolase also suggest less cerebral damage.
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Dubyts, Deanna Christine. "The experience of waiting for coronary artery bypass graft surgery". Thesis, University of British Columbia, 1988. http://hdl.handle.net/2429/27716.
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The purpose of this study W8S to explore and describe the experience of waiting for coronary artery bypass graft (CABG) surgery from the perspective of the individual who h8s a prolonged wait for this surgery. A phenomenological approach was used to guide the study. Data were collected through 17 semi-structured, audio-taped interviews with 7 men and 2 women awaiting CABG surgery. Analysis occurred concurrently with data collection. It was found that there were three interrelated core facets of the experience: the illness, the prospective surgery, and the wait. Each facet held distinct meaning: the illness represented a loss of normalcy and a threat to life; the surgery, both an opportunity to regain normalcy and a threat; and the wait, a "no control" situation which enhanced the losses and threats of the other facets, engendered further losses, and delayed the expected gain from surgery. Within each facet, representative emotional reactions, and coping strategies were identified. The findings indicate that these clients require regular contact and that nursing care must address all three facets of the experience.Applied Science, Faculty of
Nursing, School of
Graduate
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Palmgren, Ingrid. "Transesophageal Echocardiography in Patients Undergoing Elective Coronary Artery Bypass Surgery". Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2002. http://publications.uu.se/theses/91-554-5238-8/.
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Westerdahl, Elisabeth. "Effects of Deep Breathing Exercises after Coronary Artery Bypass Surgery". Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-4520.
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Poon, Chui-yuk Mabel y 潘翠玉. "The patients lived experiences after coronary artery bypass graft surgery". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2005. http://hub.hku.hk/bib/B45011692.
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Shaw, P. J. "Neurological and neurophysiological complications of coronary artery bypass graft surgery". Thesis, University of Newcastle Upon Tyne, 1987. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.380746.
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Rahman, Ishtiaq Ali. "Application of remote ischaemic preconditioning to human coronary artery bypass surgery". Thesis, University of Birmingham, 2010. http://etheses.bham.ac.uk//id/eprint/843/.
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This thesis reports a clinical study designed to assess myocardial, renal and lung outcomes following cardiac surgery. In a single centre, prospective randomized, placebo intervention-controlled trial the effects of intermittent upper limb ischaemia (remote ischaemic preconditioning (RIPC)) were compared in non-diabetic adult patients undergoing on-pump multi-vessel coronary artery surgery. Patients, investigators, anaesthetists, surgeons and critical care teams were all blind to group allocation. Subjects were randomized(1:1) to RIPC(or placebo) stimuli (3x upper limb (or dummy arm) 5 minute cycles of 200mmHg cuff inflation/deflation) during sternotomy and conduit procurement. Anaesthesia, perfusion, cardioplegia and surgical techniques were standardized. Groups were well matched on demographic and operative variables. In contrast to prior smaller studies, RIPC did not reduce troponin T (48 hour area under the curve (AUC); 6hour and peak) release, improve post-operative haemodynamics (cardiac indices; low cardiac output episodes incidence; IABP usage; inotrope and vasoconstrictor use; M mode, 2D contrastenhanced echocardiography and tissue Doppler imaging) or offer antiarrhythmic benefit (de novo left bundle branch block or Q waves; ventricular tachyarrhythmia incidence). RIPC did not afford renal (peak creatinine, AUC urinary albumin-creatinine ratios, dialysis requirement) or lung protection (intubation times, 6hour and 12 hour pO2/FiO2 ratios). Case urgency did not influence RIPC effect.
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Yogaratnam, Jeysen Zivan. "The effects of preconditioning coronary artery disease patients with hyperbaric oxygen prior to coronary artery bypass graft surgery & cardiopulmonary bypass". Thesis, University of Hull, 2011. http://hydra.hull.ac.uk/resources/hull:4803.
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IntroductionCoronary artery bypass graft (CABG) is associated with periods of ischaemia and reperfusion, which may lead to myocardial dysfunction. In clinical studies, hyperbaric oxygen (HBO2) treatment following an acute myocardial infarction (AMI), has been shown to limit myocardial injury and improve myocardial function. The primary efficacy objective of this study was to determine if systemically preconditioning coronary artery disease (CAD) patients with HBO2, prior to first time elective on cardiopulmonary bypass (CPB) CABG surgery, leads to a remote preconditioning like effect that is capable of improving myocardial function following CABG. The main secondary objectives of this study were to assess the safety of HBO2 preconditioning and, its effects on myocardial injury and post operative intensive care unit (ICU) length of stay. The exploratory secondary objectives were to assess the effects of HBO2 preconditioning on surrogate serum biomarkers of endothelial and neutrophilic adhesiveness and, myocardial biomarkers of cardioprotection. Methods In this single centre, randomised control study, 81 patients, who were having first time elective on CPB CABG surgery, were recruited. 40 were randomised to the Control Group and 41 to the HBO2 Group. Treatment with HBO2 preconditioning was completed approximately 2 hours prior to CPB and consisted of two 30 minute sessions of 100% oxygen at 2.4 atmospheres (ATA) separated 5 minutes apart. Efficacy was measured by determining peri-operative haemodynamic measurements using a pulmonary artery (PA) catheter. Safety was measured by collecting peri-operative data on myocardial injury and adverse events (AEs) and, post operative days spent in ICU. Using collected peri-operative venous blood, myocardial injury was determined by measuring the concentration of serum Troponin-T. In these same venous blood samples, endothelial and neutrophilic adhesiveness was indirectly assessed by measuring the concentrations of sE-selectin, sP-Selectin and sICAM-1 and, sPSGL-1, respectively. Using intra-operative right atrial biopsies, the degree of cardioprotection provided by HBO2 preconditioning was determined by measuring the quantity of myocardial eNOS and Hsp72. Analysis of the serum and myocardial biomarkers were done by ELISA.Results Compared to the Control Group, the HBO2 Group demonstrated a significant improvement in left venticular stroke work (LVSW) 24 hours post CPB (p=0.005). While there were no significant safety findings, there were fewer cardiovascular, pulmonary, renal and neurological AEs in the HBO2 Group. This group also had a significantly shorter post operative ICU length of stay. 1 hour post HBO2 preconditioning, the concentration of sPSGL-1 increased significantly in the HBO2 Group. At all time points, the peri-oprative concentration of sPSGL-1 was higher in the HBO2 Group but none of the changes were significant. The latter was also the case for the peri-operative concentration of sP-Selectin, apart from following the period of ischaemic and reperfusion, when it was lower in the HBO2 Group. Intra-operatively, the concentration of sE-Selectin increased significantly in the HBO2 Group and was higher in this group throughout the peri-operative period. During this intra-operative period also, the concentration of sICAM-1 was higher in the HBO2 Group and the increase was particularly significant following the period of ischaemia and reperfusion. 24 hours post CPB, the concentrations of all the serum soluble adhesion molecules were higher in the HBO2 Group. No significant differences were observed between the groups with respect to the concentrations of serum Troponin-T and, the quantity of myocardial eNOS and Hsp72. However, in the HBO2 Group, the peri-operative concentrations of serum Tropinin-T, eNOS and Hsp72 were lower. Furthermore, while there was a pre-CPB reduction of both eNOS and Hsp72, following ischaemia and reperfusion, the quantity of both these myocardial biomarkers were increased. Conclusion From this study, it can be concluded that HBO2 preconditioning of patients with CAD prior to on CPB CABG, is capable of improving myocardial function 24 hours post CABG. Additionally, the data suggest that this may also be a safe modality of treatment as it did not lead to significant post operative AEs, limited peri-operative myocardial injury and reduced post operative ICU length of stay. It also led to increased post operative concentrations of the measured surrogate biomarkers of endothelial and neutrophilic adhesiveness, with a number of significant peri-operative changes. Finally, while HBO2 treatment did not lead to significant changes in the myocardial biomarkers of cardioprotection, the quantities of these increased in the HBO2 Group following ischaemia and reperfusion, suggesting that it may be capable of inducing endogenous cardioprotection following ischaemia and reperfusion.
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Steuer, Johnny. "Perioperative Myocardial Damage and Morbidity after Coronary Artery Bypass Grafting". Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-4199.
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Herns, Mary V. "Psychological and social aspects of recovery from coronary artery vein graft surgery". Thesis, University of Surrey, 1988. http://epubs.surrey.ac.uk/844315/.
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The present study sought to improve on previous studies of open-heart surgery patients by taking a broad view of outcome/recovery. A group of male coronary artery vein graft ('CAVG') patients were followed through from time of referral to six months post-surgery and changes in physical, psychological and social functioning were monitored. The relationships between the different areas of functioning were also examined. Two aspects of psychological function, namely intellectual performance and mood, and three aspects of social function, namely social/leisure, family and work activities, were assessed. Additionally, the beliefs and experiences of the subjects and their spouses relating to the development of heart disease and to recovery from surgery were explored. A single-case research design was used in order to examine and, where possible, explain individual differences in terms of specific patterns of functioning before and after surgery. For the group as a whole, pre- to post-surgery improvements were found in physical functioning and in mood, whereas social/leisure, family and work functioning were apparently unaffected. Post-operative intellectual performance, as measured with a battery of standardised neuropsychological tests, was unimpaired in most cases. There was scare variation in outcome, however, and close examination of the individual cases revealed the importance of such factors as family relationships, social 'buffers', denial and 'hopelessness' in determining the reaction of the individual to the surgery. The findings of the present study were considered to have implications for both further research and for pre- and post-operative interventions with this patient group.
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Mikkola, R. (Reija). "Determinants and clinical implications of bleeding related to coronary artery bypass surgery". Doctoral thesis, Oulun yliopisto, 2017. http://urn.fi/urn:isbn:9789526217390.
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Abstract Coronary artery bypass grafting (CABG) is the treatment of choice for patients with three-vessel disease or left main stenosis. However, it is associated with considerable risk of perioperative complications such as myocardial infarction, stroke, infections, and mortality to which excessive bleeding is a contributing factor. This thesis aims to determine the factors involved in and clinical implications of bleeding after CABG. The 1st study evaluated the effects of preoperative ASA discontinuation on the patient’s outcome after CABG. The results showed that late or no discontinuation of low-dose ASA before CABG may decrease the risk of postoperative stroke without increasing the risk of postoperative bleeding. In the 2nd study the use of warfarin was found to be a safe during CABG with no excess bleeding nor other major complications. The 3rd study estimated the impact of surgeons´ performances on blood loss and need for re-exploration after CABG. With 2001 study patients, this study clearly demonstrated that an individual surgeon is a powerful determinant of postoperative bleeding and need for re-exploration after CABG. Using systematic review and meta-analysis, we estimated the risk of complications related to re-exploration for bleeding after CABG. In literature search in 2011, 8 articles with 557 923 patients fulfilled the inclusion criteria. Re-exploration for bleeding after cardiac surgery carries a significantly increased risk of postoperative mortality and morbidity, and thus has a major impact on the patient’s immediate postoperative outcome. We also studied the impact of blood transfusion on the development of post-operative stroke after CABG. Of the study population of 2 226 CABG patients, stroke occurred postoperatively in 53 patients (2.4%). The statistical analysis showed that transfusion of blood products after CABG has a strong, dose-dependent association with the risk of stroke. The use of Octaplas® and platelet transfusions seem to have an even larger impact on the development of stroke than red blood cell transfusions. The 6th study investigated the impact of transfusion of blood products on intermediate outcome after CABG in 2001 patients. The findings indicated that transfusion of any blood product is associated with a significant risk of all-cause and cardiac mortality after CABGTiivistelmä Sepelvaltimotauti on yleisin kuolinsyy ja sepelvaltimoiden ohitusleikkaus hyvine pitkäaikaistuloksineen on todettu parhaaksi hoidoksi potilailla, joilla on monen suonen tai vasemman päärungon tauti. Ohitusleikkaukseen liittyy kuitenkin verenvuodon sekä näihin kytkeytyvien komplikaatioiden riski. Tämän väitöskirjan tavoitteena oli määrittää verenvuodon riskitekijöitä sekä verituotteiden siirtojen vaikutusta ohitusleikkauspotilaiden ennusteeseen. Verenhyytymistä estävien lääkkeiden tiedetään lisäävän verenvuotoja. Ensimmäinen tutkimus osoitti, että ASA:n jatkaminen keskeytyksettä ohitusleikkauksissa vähentää aivoinfarktien riskiä lisäämättä silti verenvuodon riskiä. Toisessa tutkimuksessa pitkäaikainen warfariinihoito osoittautui turvalliseksi ohitusleikkauksen aikana eikä sen käyttö lisännyt verenvuotoja eikä muita komplikaatioita. Kolmas tutkimus osoitti kirurgin taidon merkityksen verenvuotojen ja uusintaleikkausten määrään 2001 potilaalla. Verenvuotojen vuoksi tehtävien uusintaleikkausten negatiivinen vaikutus postoperatiiviseen mortaliteettiin sekä morbiditeettiin on todettu yksiselitteisesti useissa tutkimuksissa. Vuonna 2011 tehdyllä systemaattisella kirjallisuuskatsauksella ja meta-analyysillä selvitimme yhteensä 557 923 ohitusleikkauspotilaan aineistosta, että verenvuodon jälkeisiin uusintaleikkauksiin liittyy huomattava kuoleman ja komplikaatioiden riski. Verenvuotoja hoidetaan yleisesti verensiirroilla, vaikkakin useat tutkimukset ovat osoittaneet verituotteiden annon lisäävän mortaliteettia sekä komplikaatioriskiä. Viides tutkimus selvitteli sepelvaltimoleikkauksissa potilaalle annettujen verituotteiden ja leikkauksen yhteydessä sairastettujen aivoinfarktien välistä yhteyttä. Osoittautui, että verituotteiden käyttöön liittyy annosriippuvaisesti lisääntynyt riski saada aivoinfarkti leikkauksen yhteydessä. Varsinkin verihiutale- ja jääplasmasiirtoihin on todettu liittyvän vielä suurempi aivoinfarktin riski kuin punasolusiirtoihin. Kuudes tutkimus selvitteli sepelvaltimoleikkauksien yhteydessä annettujen verituotteiden vaikutusta 2001 potilaan keskipitkään ennusteeseen. Tutkimus osoitti, että minkä tahansa verituotteen antoon sepelvaltimoleikkauksissa liittyy lisääntynyt kuoleman ja sydänkuoleman riski
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Goudie, Beth Ann. "The transition from hospital to home following coronary artery bypass graft surgery". Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp04/mq22742.pdf.
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Banner, Davina Jayne. "Women's experiences of coronary artery bypass graft surgery : a grounded theory approach". Thesis, University of the West of England, Bristol, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.438783.
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Coronary heart disease (CHD) is the leading cause of morbidity and mortality for both sexes in the United Kingdom Traditionally, CHD has been viewed as a disease primarily affecting /Ten with women being largely overlooked in the media, health educatbn campaigns and clinical research. Healthcare services came to reflect the generalisations formulated from studies of white middle class ruales. Consequently, inequalities exist in the recognition, diagnosis end treatment of CHD in women. Despite a growing body of literature e
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GIANNICOLA, GAIA. "COMPARISON OF TWO DISPERSION ARTERIAL CANNULAS IN CORONARY ARTERY BYPASS GRAFT SURGERY". Doctoral thesis, Università degli Studi di Milano, 2017. http://hdl.handle.net/2434/488200.
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Nonostante gli elevati progressi nelle macchine cuore-polmone e l'introduzione di nuove tecnologie, le complicanze neurologiche e le disfunzioni cognitive nei pazienti sottoposti a chirurgia di bypass aorto-coronarico (coronary artery bypass graft, CABG) con bypass cardiopolmonare (cardiopulmonary bypass, CPB) sono ancora molto frequenti. L’elevato carico embolico cerebrale durante gli interventi di CABG risulta essere l'ipotesi principale per la manifestazione di tali eventi. I fenomeni microembolici correlano con le caratteristiche e le comorbidità dei pazienti, con il sito di cannulazione arteriosa e con il design della punta della cannula arteriosa. In particolare, la tipologia di cannula utilizzata durante l’intervento influenza l’erogazione del flusso sanguigno che, se colpisce in modo non fisiologico la parete aortica, potrebbe immettere placche aterosclerotiche presenti sulla parete nel circolo sanguigno e danneggiare l'endotelio nella zona in cui il flusso colpisce la parete aortica. Per evitare tali effetti, la cannula arteriosa deve principalmente erogare elevata portata garantendo bassa pressione. Le cannule a dispersione di flusso sono state progettate con l’obiettivo di garantire queste condizioni. In numerosi studi in vitro sono state analizzate le caratteristiche di diverse cannule a dispersione di flusso e sono stati ampiamente riportati i deficit neurologici e cognitivi dopo interventi di CABG, ma nessuno ha studiato le prestazioni di cannule a dispersione di flusso in vivo e gli effetti sugli outcome neurologici e cognitivi dopo interventi di CABG.
Questo progetto si propone di valutare le prestazioni di due cannule arteriose a dispersione di flusso, Optiflow (Sorin Group Italia S.r.l., Italia) e EZ Glide (Edwards Lifesciences LLC, USA), in vivo e di studiare eventuali complicanze neurologiche e disfunzioni cognitive dopo intervento di CABG valutando possibili correlazioni con gli eventi microembolici registrati durante l’intervento. Per raggiungere questo obiettivo è stato disegnato uno studio prospettico, randomizzato (1:1), non in cieco e monocentrico. Una coorte di 23 pazienti (gruppo Optiflow N=11; gruppo EZ Glide N=12) è stata arruolata nello studio. Inizialmente, sono state valutate le prestazioni delle due cannule durante intervento di CABG in termini di emodinamica e perfusione, ed indagato possibili effetti emolitici. Sono stati successivamente analizzati gli eventi microembolici registrati durante la chirurgia e le possibili complicanze neurologiche e disfunzioni cognitive dopo CABG riportando gli eventi cardiovascolari e neurologici raccolti dopo l’intervento chirurgico e le valutazioni cognitive a tre mesi di follow-up. Infine, sono state valutate possibili correlazioni tra gli outcome cognitivi a tre mesi ed il numero di eventi microembolici registrati durante l'intervento chirurgico.
I risultati hanno suggerito che la cannula Optiflow potrebbe garantire una migliore perfusione periferica in quanto sono state osservate basse pressioni della cannula anche durante elevate portate. Questa osservazione potrebbe suggerire una riduzione del rischio di possibili danni all’endotelio nella zona in cui il flusso colpisce la parete aortica e del rischio di immissione di placche aterosclerotiche nel circolo sanguigno. I risultati mostrano che la pressione della cannula Optiflow è influenzata solo da variazioni della pressione sanguigna dei pazienti, regolabile durante l'intervento chirurgico, e non dalla portata, mentre la pressione della cannula EZ Glide è influenzata solo da cambiamenti nella portata; in quest’ultimo caso, non possiamo escludere eventuali complicanze legate alle elevate pressioni della cannula generate per garantire una ottimale perfusione periferica. Nessuna differenza tra i due gruppi di studio è emersa sugli effetti emolitici. L’analisi degli eventi microembolici registrati tra la fase di cannulazione aortica e la decannulazione, non ha mostrato alcuna differenza tra i due gruppi di studio, ma il numero di eventi è risultato maggiore durante specifiche fasi chirurgiche come la cannulazione, l’inizio della CPB e la rimozione del clamp aortico. Nonostante sia stato registrato un numero di eventi microembolici elevato durante tali fasi chirurgiche, nessuno dei pazienti ha sviluppato complicanze neurologiche o disfunzioni cognitive fino a tre mesi dopo l'intervento chirurgico. I dati psicologici e neuropsicologici non hanno evidenziato differenze tra i due gruppi di studio; inoltre le perfomance cognitive dei singoli pazienti, non hanno mostrato deficit o peggioramenti tre mesi dopo l'intervento chirurgico. Infine, l’analisi sulla possibile correlazione tra i dati di ciascun test neuropsicologico e gli eventi microembolici non ha mostrato alcun risultato significativo.
Questo studio pilota ha evidenziato che entrambe le cannule arteriose a dispersione di flusso, Optiflow e EZ Glide, hanno ottime prestazioni e non correlano con complicanze neurologiche o disfunzioni cognitive dopo interventi di CABG. Sebbene la cannula Optiflow prometta di garantire prestazioni superiori alla cannula EZ Glide, sono necessari ulteriori studi per confermare i nostri risultati preliminari.Neurological complications and cognitive dysfunctions in patients undergoing coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass (CPB) remain common outcomes despite CPB machines advances and introduction of new technologies. Cerebral embolic load during CABG surgery is the main hypothesis for occurrence of those events. Embolization strongly relates to patients’ characteristics and comorbidities, arterial cannulation site and tip shape of the arterial cannula. Based on cannula tip shape used during surgery, the jet stream of arterial tip cannula differently affects atherosclerotic plaques and could also damage endothelium in the area where the cannula jet hits the aortic wall. Desired features of arterial cannulas, to prevent those effects, are mainly high flow with low pressure. Dispersion cannulas were designed to achieve those features. Studies described dispersion cannulas performances in vitro and neurological and cognitive outcomes after CABG, but none compared dispersion flow arterial cannulas performances in vivo and their effects on neurological and cognitive outcomes after CABG. This project aims to evaluate performances of two dispersion flow arterial cannulas, Optiflow (Sorin Group Italia S.r.l., Italy) and EZ Glide (Edwards Lifesciences LLC, USA), in vivo and to study any neurological complications and cognitive dysfunctions after CABG surgery seeking any possible correlations with microembolic events. To do so, we designed a prospective, randomized (1:1), non-blinded, monocentric study. A cohort of 23 patients (Optiflow group N=11; EZ Glide group N=12) was enrolled. First, we analyzed cannulas performances during CABG surgery in terms of hemodynamic and perfusion and investigated possible hemolytic effect. We analyzed microembolic events recorded during surgery and possible neurological complications and cognitive dysfunctions after CABG both monitoring any cardiovascular and neurological events occurred after surgery and cognitive assessments at three-month follow-up visit. Finally, we sought for any possible correlation between cognitive outcomes assessed at three-month follow-up visit and number of microembolic events recorded during surgery. Results suggested that Optiflow cannula could guarantee a better peripheral perfusion because low cannula pressures were observed during the full procedure and even during high flow rates. This observation could imply reduced risk of possible endothelium damages in the area in which the cannula jet hits the aortic wall and reduced risk of atherosclerotic plaques dislodgement. Indeed, results showed that Optiflow cannula pressure is only influenced by changes in patients’ blood pressure, that could be adapted during surgery, and not by flow rate, whereas EZ Glide cannula performance is only influenced by changes in flow rate; hence, for EZ Glide cannula, in the attempt of reaching optimal perfusion we cannot exclude possible complications due to high cannula pressure induced by high flow rates. No differences on hemolytic effects were found. When we studied the microembolic events recorded from aortic cannulation to decannulation phase, we found no differences between the two study groups, but in general the number of events was higher during specific ‘surgical events’ such cannulation, CPB onset and aortic cross clamp removal. Despite a higher number of microembolic events recorded during those 'surgical events', none of the patients had neurological complications or cognitive dysfunctions up to three months after surgery. Psychological and neuropsychological data showed no differences between the two study groups; when the analysis focused on single patient behavior, no deficit or worsening were observed at three-month follow-up visit compared to baseline. Finally, when we tested whether neuropsychological outcomes correlated with microembolic events we found no correlation. This pilot study showed that both Optiflow and EZ Glide dispersion flow arterial cannulas have good performances and do not correlate with any neurological complications or cognitive dysfunctions after CABG surgery. Although the Optiflow cannula promises to guarantee higher performances than EZ Glide, future studies are needed to confirm our preliminary results.
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Vallely, Michael. "Inflammation, coagulation and off-pump cardiac surgery / by Michael Vallely". Thesis, The University of Sydney, 2005. https://hdl.handle.net/2123/27959.
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An estimated 800,000 patients per year worldwide undergo coronary artery bypass grafting (CABG), with significant survival and quality of life benefits. CABG may be performed with (on-pump) or without (off-pump) cardiopulmonary bypass (CPB).
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Speiser, Bernadette Susan. "The relationship of threat appraisal and coping patterns in coronary artery bypass patients". Virtual Press, 1992. http://liblink.bsu.edu/uhtbin/catkey/845964.
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Coronary bypass surgery is an increasingly common occurrence. Current literature does not validate the coping mechanisms involved for patients facing this life-threatening event. Lazarus’ theory of stress and coping was utilized as the framework for the study. The purpose of the study was to identify the degree of threat coronary bypass surgery presents and coping mechanisms utilized with this specific insult. The significance of the study was to assist nurses in identification of perceived risks/benefits of having open heart surgery from the patient’s perspective. The population included patients from a private cardiovascular practice in Indianapolis, Indiana. The convenience sample included 38 subjects recovering from coronary bypass graft surgery. Subjects were identified as uncomplicated post-operative surgical patients and were mailed questionnaires one month after discharge from the hospital. The Jalowiec Coping Scale and a questionnaire for demographic data were utilized to collect data. Procedures for protection of human subjects were followed. The research design was non-experimental and descriptive, correlational procedures were utilized to analyze data.The data supported the notions that clients utilized both problem-focused coping and emotion-focused coping, and emotion-focused coping strategies were more effective in reducing the threat. Education was significantly related to emotive coping styles and clients that perceived a higher threat intensity utilized more emotion-focused coping strategies. Recognition of the need to minimize stressors can be an important role the nurse facilitates. Through participatory care, the nurse may assist in finding the meaning for the stressor and encourage open communication patterns and emotional responses. Allowing for reduction of threat perception and intensity may enhance the outcome of the experience.School of Nursing
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Dreifaldt, Mats. "Conduits in coronary artery bypass grafting surgery : Saphenous vein, radial and internal thoracic arteries". Doctoral thesis, Örebro universitet, Institutionen för hälsovetenskap och medicin, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-33265.
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A novel technique for saphenous vein (SV) graft harvesting, the No-touch technique (NT), has been developed at the Dept. of Cardiovascular surgery, Örebro University hospital. With NT the SV is harvested with a pedicle of surrounding tissue. This avoids graft spasm and eliminates the need for distension. The surrounding tissue acts as a structural support and is a rich source of vaso-dilating agents. A randomized controlled trial (RCT) has shown a significantly higher patency rate for NT SV grafts compared to SV grafts harvested with conventional technique (CT). This thesis evaluates some of the properties of the surrounding tissue and compares patency rates between NT SV and radial artery (RA) grafts and patency rates for internal thoracic artery (ITA) grafts harvested with and without surrounding tissue. Paper I investigated vasa vasorum (VV) in SV grafts and showed that the NT preserves an intact VV whereas CT does not. This could be one of the mechanisms underlying the improved patency for NT SV grafts. Paper II evaluated VV and associated nitric oxide (NO) in SV and arterial grafts. SV grafts showed a higher number and larger VV, which correlated with NO production, compared to arterial grafts. NT SV grafts showed higher activity for e-NOS compared to CT SV grafts. Paper III is a RCT comparing patency rates between NT SV and RA grafts, three years after surgery, showing a significantly higher patency rate for NT SV grafts. Paper IV is a RCT comparing patency rates for ITA graft harvested with and without surrounding tissue and did not show any difference between graft preparations. In conclusion, the NT for SV graft harvesting preserves an intact vasa vasorum and associated NO production. NT SV grafts show a higher patency rate than RA grafts. Harvesting of ITA with or without surrounding tissue does not affect patency rate.
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Al-Ruzzeh, Sharif Mohamed Hasan Khalaf. "Outcome of coronary artery bypass graft surgery with and without cardio-pulmonary bypass". Thesis, Imperial College London, 2003. http://hdl.handle.net/10044/1/8394.
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Valentine, Sarah y n/a. "Neuropsychological functioning of patients before and after undergoing coronary artery bypass graft surgery". University of Otago. Dunedin School of Medicine, 2007. http://adt.otago.ac.nz./public/adt-NZDU20070803.140127.
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Cardiovascular disease (CVD) affects millions of people worldwide. Many of these people require treatment for their condition, and for roughly a million individuals each year, this treatment includes coronary artery bypass graft (CABG) surgery - a procedure that aims to restore proper blood flow to the arteries of the heart. Although the physical impact of CVD and CABG surgery are well-known, their cognitive impact has not been clearly established. Recent studies suggest that both CVD and CABG surgery may have a detrimental effect on neuropsychological functioning. The first goal of the present study was to cognitively assess patients with severe, chronic CVD to determine the association of heart disease with neuroopsychological functioning. The second goal was to then continue monitoring these patients once they had undergone CABG surgery to establish what cogntive effect this treatment has.
CABG surgery has traditionally been performed with the aid of a cardiopulmonary bypass (CPB) machine, but in the past decade, another technique, in which the heart remains beating, has been developed. Some have argued that this beating heart surgery (BHS) may be a superior alternative to the CPB procedure. Consequently, the third goal of the present study was to compare outcomes in patients undergoing these two surgical procedures.
The present study had a prospective, double blind design. Patients were randomly assigned to either CPB surgery (CPBS) or BHS. Sixty-three patients were recruited and underwent a comprehensive neuropsychological assessment preoperatively and 6 days, 6 weeks and 30 weeks postoperatively.
Despite including a higher risk group than previous comparative studies, there were virtually no differences between the CPBS and BHS groups. When the groups were combined and the sample was examined as a whole, the patients were cognitively impaired even before their surgery. Given that their premorbid abilities were estimated to be in the average range, their pre-surgery deficits were likely to be the result of a long-standing history of CVD.
Immediately after surgery (Day 6), the neuropsychological performance of the sample decreased further, but they had significantly improved by Week 6 and this improvement increased further by the Week 30 time-point (with many scores in the average range). This postoperative recovery suggests that the decline these patients exhibit preoperatively may be reversible and that rather than causing cognitive deficits, CABG surgery may ultimately improve both cardiac and cognitive health.
Psychologically, patients in the present sample reported the highest level of anxious and depressive symptoms, and the lowest quality of life, pre-surgically, but their psychological health gradually improved over the course of the postoperative period. Compared to other samples, however, the present sample were generally psychologically healthy.
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Estabrooks, Lorna E. "Gender patterns and behaviours to manage early recovery following coronary artery bypass surgery". Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp05/mq24639.pdf.
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Adderley, Natasha Lorraine. "Intrathecal morphine for analgesia following coronary artery bypass graft surgery, a pilot study". Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk2/tape17/PQDD_0024/MQ36388.pdf.
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Shuldham, Caroline. "The impact of pre-operative education on recovery following coronary artery bypass surgery". Thesis, Imperial College London, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.312550.
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Sandborn, Spiess Frances Ann. "How do women differ from men in recovery from coronary artery bypass surgery". Honors in the Major Thesis, University of Central Florida, 1998. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/53.
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This item is only available in print in the UCF Libraries. If this is your Honors Thesis, you can help us make it available online for use by researchers around the world by following the instructions on the distribution consent form at http://library.ucf.edu/Systems/DigitalInitiatives/DigitalCollections/InternetDistributionConsentAgreementForm.pdf You may also contact the project coordinator, Kerri Bottorff, at kerri.bottorff@ucf.edu for more information.Bachelors
Health and Public Affairs
Nursing
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Lester, Arnette Sandland 1952. "Orthostatic blood pressure and heart rate responses after coronary artery bypass graft surgery". Thesis, The University of Arizona, 1990. http://hdl.handle.net/10150/277795.
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A quasi-experimental study was conducted to compare preoperative and postoperative postural responses to position change. A convenience sample of 30 men and women admitted for elective coronary artery bypass graft (CABG) surgery performed supine to sitting and supine to standing position changes prior to surgery and on postoperative day two or three. An ANOVA with repeated measures compared the responses of systolic blood pressure, diastolic blood pressure and heart rate. Systolic blood pressure exhibited a significant change from preoperative to postoperative measurements. Diastolic blood pressure remained the same; heart rate changed over time, but no significant preoperative to postoperative changes occurred. Comparison of normotensive and hypertensive subjects revealed reduced postoperative responsiveness in the hypertensive subjects for systolic blood pressure and heart rate. Nurses caring for postoperative CABG patients should anticipate a reduction in blood pressure and an increase in heart rate upon standing.
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Mills, Benjamin Colin. "Regional Cerebral Oxygen Desaturations in Coronary Artery Bypass Surgery: A Minimally Invasive Approach". Thesis, The University of Arizona, 2013. http://hdl.handle.net/10150/293646.
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Cerebral oximetry has been shown to effectively identify declining regional cerebral oxygen saturations (rSO2) in coronary artery bypass graft (CABG) surgery. Prolonged intraoperative cerebral desaturations have been significantly associated with an increased risk of cognitive decline after CABG surgery. We compared conventional CABG to minimally invasive robotic coronary artery bypass surgery (r-CABG) using cerebral oximetry to determine the beneficial effects of the less invasive procedure. A retrospective study of 32 isolated CABG patients were treated for coronary artery disease (CAD) via conventional CABG (n=20) or r-CABG (n=12) with analysis of cerebral oximetry tracings and intraoperative data. Parameters, such as, blood loss, mean arterial pressure (MAP), partial pressure of carbon dioxide (PaCO2), cardiopulmonary bypass (CPB), and diabetes mellitus (DM) were analyzed against the area under the curve (AUC) from the cerebral oximetry tracing, an indicator of rSO2 desaturations. Many of these parameters showed statistical significance (p<0.05) between conventional CABG and r-CABG including a decreased mean AUC in the latter. In conclusion, minimally invasive r-CABG tends to show beneficial effects for patients by reducing the total mean AUC in comparison to conventional CABG, especially in the DM patient.
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Yui, Patrick. "Nitric oxide in vascular injury : a study using nitric oxide synthase knockout mice and adenoviral gene transfer in rabbit carotid vein grafts". Thesis, University College London (University of London), 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.396248.
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Anis, Rafik Ramsis. "Coronary collateral circulation: effect on outcome after off-pump coronary artery bypass surgery and implication on revascularization strategy". Thesis, University of Bristol, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.492627.
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Hong, Serena Sungyun. "Pain management after coronary artery bypass graft surgery, particularly in relation to physiotherapy interventions". Thesis, The University of Sydney, 2018. http://hdl.handle.net/2123/20257.
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The overall aim of the thesis was to evaluate physiotherapy and pain management in patients after coronary artery bypass graft (CABG) surgery and to determine the interaction between these. The thesis contains a literature review (Chapter 1), three research studies (Chapters 2-4), and a discussion (Chapter 5). The literature review provides an overview of CABG surgery, postoperative pain management and physiotherapy management. Chapter 2 reports the findings of a survey of centres in Australia and New Zealand that perform CABG surgery, to determine current physiotherapy mobility and walking management, expected clinical milestones and physiotherapists’ perception of pain severity in patients undergoing uncomplicated CABG surgery. Chapter 3 was a systematic review with meta-analyses designed to determine the effectiveness of continuous infusion of local anaesthetic (CLA) on pain and mobilisation post cardiac surgery. Chapter 4 was a prospective, multi-centre, randomised controlled trial (RCT) that evaluated the effect of continuous infusion of 0.5 % Ropivacaine via PainBuster, parasternally post CABG surgery compared to either a sham intervention of normal saline infusion via the PainBuster, or usual care. Overall, these studies have shown that a key role of physiotherapy after CABG surgery was patient mobilisation (based on the survey) and that continuous infusion of local anaesthetic agents around the wound sites after CABG surgery improved pain scores and reduced morphine requirements and time to first walk (based on the systematic review), however the randomised controlled trial of continuous infusion of local anaesthetics via PainBuster did not show a reduction of pain or an increased walking distance or shortened time to discharge from physiotherapy compared to patients who received a sham intervention or usual care. Chapter 5 summarises these main findings and discusses limitations, clinical practice implications, and suggestions for future research.
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Jidéus, Lena. "Atrial Fibrillation after Coronary Artery Bypass Surgery : A Study of Causes and Risk Factors". Doctoral thesis, Uppsala University, Department of Surgical Sciences, 2001. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-1488.
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The aim was to study pathophysiological mechanisms and risk factors for developing atrial fibrillation (AF) after coronary artery bypass grafting (CABG), and the effect of thoracic epidural anaesthesia (TEA).
The study comprised 141 patients undergoing CABG, including 45 patients randomised for TEA intra- and postoperatively. All patients underwent 24-hour Holter monitoring pre- and postoperatively for the analysis of arrhythmias and heart rate variability (HRV). Catecholamines and neuropeptides (reflecting sympathetic and parasympathetic activity), atrial peptides and echocardiographically assessed atrial arias were obtained pre- and postoperatively.
Logistic regression analysis identified body mass index (BMI), maximum supraventricular beats (SPB) per minute, and total amount of cardioplegia as independent predictors of postoperative AF. Patients developing AF showed limited diurnal variation of HRV preoperatively. All HRV parameters decreased significantly in all patients postoperatively. The significant postoperative increase in atrial areas and atrial peptides did not differ between patients developing AF and those who did not. TEA had no effect on the incidence of postoperative AF, but resulted in lower heart rate, less increase in adrenaline levels, and decreased neuropeptide levels (reflecting sympathetic and parasympathetic activity). AF was initiated by an SPB in 72.4% of non-TEA and 100% of TEA treated patients, whereas changes in heart rate only, before onset, were seen in 17.2% non-TEA patients.
The observed risk factors, SPB and cardioplegia, may both induce electrophysiological changes known to increase the susceptibility to AF. The observed postoperative atrial dilatation and autonomic imbalance, indicated by HRV and neuropeptide levels, may further favour the development of AF. The observation that a majority of postoperative AF was initiated by a premature atrial contraction supports our hypothesis that latent atrial foci may be a major trigger mechanism of postoperative AF.
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Engel, Amy M. "The Impact of Body Mass Index on Hospital Outcomes following Coronary Artery Bypass Graft Surgery". University of Cincinnati / OhioLINK, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1240590704.
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Ghahramani, Melody. "Simultaneous modelling of long- and short-term survival after coronary artery bypass graft surgery". Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk2/tape17/PQDD_0018/MQ37536.pdf.
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Alhashemi, Jamal A. "Effect of subarachnoid morphine administration on extubation time following coronary artery bypass graft surgery". Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp03/MQ39800.pdf.
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Jidéus, Lena. "Atrial fibrillation after coronary artery bypass surgery : a study of causes and risk factors /". Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2001. http://publications.uu.se/theses/91-554-5151-9/.
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