Articles de revues : « CABGs »

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Mandell, Harvey N. « Of CABGs and Kings ». Postgraduate Medicine 84, n^o 6 (novembre 1988) : 50–56. http://dx.doi.org/10.1080/00325481.1988.11700461.

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Ramarao, Venugopal, Chandana N. C. et Sunil P. K. « Role of emergency coronary artery bypass grafting in the era of percutaneous interventions ». International Surgery Journal 7, n^o 4 (26 mars 2020) : 1071. http://dx.doi.org/10.18203/2349-2902.isj20201171.

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Background: In acute coronary syndrome, prompt restoration of myocardial blood flow is essential to optimize myocardial salvage and decrease mortality. Coronary artery reperfusion, if performed in a timely manner improves clinical outcomes compared to no reperfusion. Fibrinolysis and percutaneous interventions can restore blood flow in an acutely occluded coronary artery in most of the patients; but in a few subset of patients coronary artery bypass grafting (CABG) is needed to effectively restore blood flow.Methods: A retrospective study was conducted among all CABGs performed during March 2016 - February 2018. During this period, 366 CABGs were performed and 57 patients underwent emergency CABG as per the inclusion criterias. Pre-operative, intra-operative and post-operative data was analysed of these patients. Patients were divided into four groups based on the time of surgery from the time of onset of myocardial infarction. Results: 57 patients underwent emergency CABG with males constituting 94.7% of the study population. 78.9% of them had an ejection fraction less than 35%. 52% presented with low cardiac output status, 10% needed intra-aortic balloon pump support and 15% required mechanical ventilation prior to surgery. All patients received an average of 2.8 grafts. Mortality was 5%Conclusions: Immediate surgical revascularisation of patients presenting with acute MI is feasible. Emergency CABG not only treats the culprit lesion but also achieves complete revascularization and offers a clear advantage for patients. The optimal timing of CABG for patients with acute MI remains difficult to establish.

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Perrotti, Andrea, Enrica Dorigo, Camille Durst, Djamel Kaili, Sidney Chocron et Amedeo Spina. « Exclusive Bilateral Internal Thoracic Artery Grafts for Myocardial Revascularization Requiring Four Anastomoses or More : Outcomes from a Single Center Experience ». Thoracic and Cardiovascular Surgeon 65, n^o 04 (1 juillet 2016) : 265–71. http://dx.doi.org/10.1055/s-0036-1584688.

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Introduction Multivessel coronary artery bypass graft (CABG) with bilateral internal thoracic arteries (BITA) has only been uncommon and technically demanding. We describe our experience with BITA only CABGs requiring ≥ 4 anastomoses. Material and Methods The department's database was queried for patients undergoing isolated CABG with ≥ 4 anastomoses. The surgical technique included systematically a right internal thoracic artery (ITA) of left ITA Y graft. The multivariate model included variables with a p < 0.3 at univariate analysis. Results Between January 2006 and December 2009, 251 consecutive patients (71 ± 10 years) (on-pump: 130, off-pump: 121) had CABG with ≥ 4 anastomoses, representing 21% of total isolated CABGs for the same period; all patients received a totally arterial BITA only revascularization. Follow-up was 4.9 ± 1.6 years. Overall and cardiac cumulative survivals were 78 and 92%, respectively, at 5 years. The occurrence of any major postoperative complication was associated with overall and cardiac mortality (odds ratio [OR]: 3.6, 95% confidence interval [CI]: 1.3–9.9 and OR: 5.4, 95% CI: 1.3–21.9, respectively). Major sternal wound complication requiring surgical revision was not associated with impaired glucose control (n = 9; diabetics: 6/82, 7.3%; nondiabetics: 3/169, 1.8%, p = 0.06). Preoperative kidney failure was associated with incomplete revascularization (OR: 6.2; 95% CI: 1.2–33.5), that was unfailingly due to ungraftable right coronary artery targets. Discussion BITA only revascularization was a valuable and safe procedure, with favorable results in terms of morbidity and mortality at a 5 years' follow-up.

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Shehata, Nadine, Kumanan Wilson, David Mazer, Paul Hebert, David Streiner, George Tomlinson et Gary Naglie. « Factors Affecting Physicians’ Decisions to Transfuse Red Blood Cells to Patients Having Coronary Artery Bypass Graft Surgery : A National Survey. » Blood 104, n^o 11 (16 novembre 2004) : 2715. http://dx.doi.org/10.1182/blood.v104.11.2715.2715.

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Abstract Decisions about when to transfuse patients having coronary artery disease may impact on patient morbidity and mortality. There is no published data about the factors that influence physicians’ decisions to transfuse red blood cells (RBCs) to patients having coronary artery bypass graft surgeries (CABGs). The objective of this study was to determine the hemoglobin transfusion thresholds and the factors that influence physicians’ decisions when transfusing CABG patients. Methods: This was a cross-sectional study using self-administered mailed questionnaires sent to all anesthesiologists and cardiovascular surgeons in Canada. The survey included a series of patient scenarios for which respondents were to indicate the Hb concentration below which they would transfuse the patient. Factors assessed in the survey included patient age, sex, cardiac index (CI), and myocardial ischemia (MI). Each factor was introduced consecutively in the case scenarios to allow for analysis of each factor separately and the interaction of factors. Data on physicians’ characteristics were also collected. Univariate analysis and mixed effects regression modelling were used to analyze the data. Results: The overall response rate was a 69.3%(n=339/489); 66.8% of all anesthesiologists and 75.7% of all cardiac surgeons responded. Responses were received from anesthesiologists in all 32 cardiac centres in Canada and from cardiac surgeons in 31/32 centres. The mean age of physicians was 46 years (standard deviation (sd)=8.6 years), years of practice was 14 years (sd=8.7 years), CABG cases/centre was 940 (sd=479) and CABG cases/individual was 121 (sd=77). The Hb transfusion thresholds for 6/24 case scenarios are illustrated in the Table. The Hb thresholds were similar for male patients. Univariate analysis revealed that for the base case scenario (i.e. 55 year old male/female), Hb thresholds did not differ significantly according to physician age, sex, years in practice, specialty, academic centre, the number of CABGs/centre/year, or patient sex but differed according to the number of CABGs/individual physician/year (p=0.009 for female case scenario and p=0.02 for the male case scenario), patient age (p<0.001), CI (p<0.001) and MI (p<0.001). Physicians selected the Hb concentration (51%), blood loss (21%), and MI (13%) as the most significant factor affecting their decision to transfuse. Conclusion: Patient age, CI, MI and the number of CABGs/individual physician were found to influence physicians’ transfusion decisions. Future studies are required to elucidate whether transfusions based on these variables affect patient morbidity and mortality. Table: Mean Hemoglobin Transfusion Thresholds For 6 Case Scenarios Case Scenario Mean Hemoglobin (g/L) Standard Deviation (g/L) yo=year old, CI=cardiac index, MI=myocardial ischemia 55 yo female 70 8 55 yo female, CI<2 79 10 55 yo female with MI 78 10 75 yo female 74 8 75 yo female, CI<2 82 10 75 yo female with MI 81 10

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Groom, Robert, Joan Tryzelaar, Richard Forest, Kevin Niimi, Giovanni Cecere, Desmond Donegan, Saul Katz et al. « Intra-operative quality assessment of coronary artery bypass grafts ». Perfusion 16, n^o 6 (décembre 2001) : 511–18. http://dx.doi.org/10.1177/026765910101600611.

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Early coronary artery bypass graft (CABG) failure is a troubling complication that may result in a wide range of problems, including refractory angina, myocardial infarction, low cardiac output, arrhythmia, and fatal heart failure. Early graft failures are related to poor quality and size of the distal native vascular bed, coagulation abnormalities, or technical problems involving the graft conduits and anastomoses. Unfortunately, graft failure is difficult to detect during surgery by visual assessment, palpation, or conventional monitoring. We evaluated the accuracy and utility of a transit-time, ultrasonic flow measurement system for measurement of CABGs. There were no differences between transit-time measurements and volumetric-time collected samples in an in vitro circuit over a range of flows from 10 to 100 ml/min (Bland and Altman Plot, 1.96 SD). Two hundred and ninety-eight CABGs were examined in 125 patients. Graft flow rate was proportional to the target vessel diameter. Nine technical errors were detected and corrected. Flow waveform morphology provided valuable information related to the quality of the anastamosis, which led to the immediate correction of technical problems at the time of surgery.

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Lee, Geraldine A. « Patients Reported Health-Related Quality of Life Five Years Post Coronary Artery Bypass Graft Surgery – A Methodological Study ». European Journal of Cardiovascular Nursing 7, n^o 1 (mars 2008) : 67–72. http://dx.doi.org/10.1016/j.ejcnurse.2007.07.005.

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Background: The number of individuals undergoing Coronary Artery Bypass Graft Surgery (CABGS) to treat coronary artery disease is steadily increasing. Aim: The purpose of the study was to describe the cohort's characteristics, their angina and breathless symptoms and report health-related quality of life (HRQoL) five years after CABGS. Methods: One hundred and twenty-eight patients participated in the follow-up study using the quality of life Short-Form 36 (SF-36) questionnaire. Angina and breathless symptoms were also recorded. Results: One hundred and nine patients were interviewed (face-to-face) and 19 completed postal questionnaires. The SF-36 component summaries of the face-to-face patients indicated that their physical (PCS) and mental (MCS) health was relatively good (45.8 and 53.6, respectively, with 0 = worst health and 100 = best health and 50 being the mean score), compared to the postal patients' mean PCS of 30.8 ( p < .001). The postal MCS was also lower but not statistically significant (49.6, p = .081). At follow-up, the majority of patients were asymptomatic in terms of angina and breathlessness compared to their pre-operative status. Conclusion: The findings demonstrate that patient perceived HRQoL five years after CABGS is generally good and patients remain relatively asymptomatic although data collection methods highlight differences in physical HRQoL.

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Flood, Ann Barry. « On Saving Time and Saving Money in CABGs ». Medical Care 28, n^o 1 (janvier 1990) : 3–5. http://dx.doi.org/10.1097/00005650-199001000-00002.

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Ghorbani, Banafsheh, Alun C. Jackson, Mohammad Noorchenarboo, Mohammad H. Mandegar, Farshad Sharifi, Zohrehsadat Mirmoghtadaie et Fatemeh Bahramnezhad. « Comparing the Effects of Gamification and Teach-Back Training Methods on Adherence to a Therapeutic Regimen in Patients After Coronary Artery Bypass Graft Surgery : Randomized Clinical Trial ». Journal of Medical Internet Research 23, n^o 12 (10 décembre 2021) : e22557. http://dx.doi.org/10.2196/22557.

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Background Patients undergoing coronary artery bypass graft surgery (CABGS) may fail to adhere to their treatment regimen for many reasons. Among these, one of the most important reasons for nonadherence is the inadequate training of such patients or training using inappropriate methods. Objective This study aimed to compare the effect of gamification and teach-back training methods on adherence to a therapeutic regimen in patients after CABGS. Methods This randomized clinical trial was conducted on 123 patients undergoing CABGS in Tehran, Iran, in 2019. Training was provided to the teach-back group individually. In the gamification group, an app developed for the purpose was installed on each patient’s smartphone, with training given via this device. The control group received usual care, or routine training. Adherence to the therapeutic regimen was assessed using a questionnaire on adherence to a therapeutic regimen (physical activity and dietary regimen) and an adherence scale as a pretest and a 1-month posttest. Results One-way analysis of variance (ANOVA) for comparing the mean scores of teach-back and gamification training methods showed that the mean normalized scores for the dietary regimen (P<.001, F=71.80), movement regimen (P<.001, F=124.53), and medication regimen (P<.001, F=9.66) before and after intervention were significantly different between the teach-back, gamification, and control groups. In addition, the results of the Dunnett test showed that the teach-back and gamification groups were significantly different from the control group in all three treatment regimen methods. There was no statistically significant difference in adherence to the therapeutic regimen between the teach-back and control groups. Conclusions Based on the results of this study, the use of teach-back and gamification training approaches may be suggested for patients after CABGS to facilitate adherence to the therapeutic regimen. Trial Registration Iranian Registry of Clinical Trials IRCT20111203008286N8; https://en.irct.ir/trial/41507

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Khalilipur, Ehsan. « When 7 times angioplasty on Saphenous Vein graft would not compete the Native vessel Percutaneous Coronary intervention ». Clinical Cardiology and Cardiovascular Interventions 4, n^o 7 (8 avril 2021) : 01–04. http://dx.doi.org/10.31579/2641-0419/150.

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Coronary artery bypass graft (CABG) has been the first option for revascularization in multiple vessel coronary artery disease. One of the most major obstacles after CABGs is atherosclerotic changes of SVGand more than 50 percent ofSVGare occluded at 10 years and 25 percent show severe stenosis at angiographic follow-up. Whether native vessel percutaneous coronary intervention (PCI) on native vessel or saphenous vein graft intervention is of benefit in these patients is still a debate. In this case report we want to clarify a common clinical scenario in a patient with prior CABG seven years ago which a proper decision in the right time could save many futile efforts. The patient underwent 7 PCI on the diseased SVG on OM with frequent occlusion due to stent thrombosis and in-stent restenosis which finally native vessel antegrade CTO PCI alleviated the problem and patient followed up 2 months after the procedure without any chest pain in his ordinary activities.

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Wang, Haoran, Hitomi Anzai, Youjun Liu, Aike Qiao, Jinsheng Xie et Makoto Ohta. « A Hemodynamic-Based Evaluation of Applying Different Types of Coronary Artery Bypass Grafts to Coronary Artery Aneurysms ». Complexity 2020 (10 juin 2020) : 1–10. http://dx.doi.org/10.1155/2020/9359340.

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Coronary artery bypass grafts (CABGs), including saphenous vein grafts (SVGs) or left internal mammary artery (LIMA) grafts, are recently applied to treat coronary artery aneurysm (CAA). Surgical outcomes are considered to be related to surgical strategies (types of the bypass graft and whether CAA ligated or not) and the size of the CAA (usually characterized by diameter). However, the understanding of the relationship between the surgical outcomes and the abovementioned factors is limited. Previous studies related to CABG treatments have shown hemodynamic studies could help evaluate surgical outcomes through graft mass flow rate, wall shear stress (WSS), and oscillatory shear index (OSI). It is believed that the hemodynamic study of applying CABGs to CAA, which is not studied yet, could help us understand the different CABG surgeries. The aim of the study was to evaluate the hemodynamic differences among different surgical methods. To do this, eight three-dimensional models were constructed, representing application of SVGs and LIMA grafts to CAAs (whether ligated or not) with diameters two, three, and five times the normal diameter, to perform computational fluid dynamics (CFD) simulation. The lumped-parameter model (LPM) was coupled to the boundary of the 3D models which increase the complexity of the simulation, but it can ensure the stability of the simulation boundary conditions. The results show that SVG (no matter whether ligated or not) hemodynamic characteristics are positive, with an average high graft mass flow rate of 70 ml/min, an average WSS of 0.479 Pa, and a low OSI of 0.001. LIMA with CAA ligation has the same characteristics with higher WSS (average 1.701 Pa). The hemodynamic characteristics of LIMA without CAA ligation are negative, including high reverse mass flow rate and high OSI (0.367). The results indicate that the surgical outcomes of LIMA with CAA ligation are likely to be the best among these models. The surgical outcomes of LIMA without CAA ligation seem to be undesirable due to the high reverse mass flow and high OSI. The CAA diameter may not have a significant effect on surgical outcomes.

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Biancari, Fausto, Antonio Salsano, Francesco Santini, Marisa De Feo, Magnus Dalén, Qiyao Zhang, Giuseppe Gatti et al. « Late Myocardial Infarction and Repeat Revascularization after Coronary Artery Bypass Grafting in Patients with Prior Percutaneous Coronary Intervention ». Journal of Clinical Medicine 11, n^o 19 (28 septembre 2022) : 5755. http://dx.doi.org/10.3390/jcm11195755.

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Objectives: The aim of the present study was to evaluate the risk of late mortality and major adverse cardiovascular and cerebral events after coronary artery bypass grafting (CABG) in patients with prior percutaneous coronary intervention (PCI). Methods: A total of 2948 patients undergoing isolated CABGs were included in a prospective multicenter registry. Outcomes were adjusted for multiple covariates in logistic regression, Cox proportional hazards analysis and competing risk analysis. Results: In all, 2619 patients fulfilled the inclusion criteria of this analysis. Of them, 2199 (79.1%) had no history of PCI and 420 (20.9%) had a prior PCI. An adjusted analysis showed that a single prior PCI and multiple prior PCIs did not increase the risk of 30-day and 5-year mortality. Patients with multiple prior PCIs had a significantly higher risk of 5-year myocardial infarction (SHR 2.566, 95%CI 1.379–4.312) and repeat revascularization (SHR 1.774, 95%CI 1.140–2.763). Similarly, 30-day and 5-year mortality were not significantly increased in patients with prior PCI treatment of single or multiple vessels. Patients with multiple vessels treated with PCI had a significantly higher risk of 5-year myocardial infarction (SHR 2.640, 95%CI 1.497–4.658), repeat revascularization (SHR 1.648, 95%CI 1.029–2.638) and stroke (SHR 2.215, 95%CI 1.056–4.646) at 5-year. The risk for repeat revascularization was also increased with a prior single vessel PCI, but not for other outcomes. Conclusions: Among patients undergoing CABGs, multiple prior PCIs seem to increase the risk of late myocardial infarction and the need for repeat revascularization, but not the risk of mortality.

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Inamdar, A., S. Inamdar, V. Gaikwad, P. Reddy et K. Bhagwat. « Experience with right ventricular assist device for off-pump CABGS ». Indian Journal of Thoracic and Cardiovascular Surgery 20, n^o 1 (janvier 2004) : 5. http://dx.doi.org/10.1007/s12055-004-0292-4.

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Mattar, Heba Al, Rochelle Wynne, Shan Shan Law et James Tatoulis. « Glycemic Control in Adults With Continuous Insulin Infusion After CABGS ». Chest 140, n^o 4 (octobre 2011) : 500A. http://dx.doi.org/10.1378/chest.1119082.

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Ott, Richard A., Robert Steedman, John Eugene, Amrit Dajee, Wendy Ott et Teresa Tanner. « Reoperative Coronary Bypass Surgery Using Normothermic Cardiopulmonary Bypass : Comparison with First-Time Procedures ». American Surgeon 67, n^o 12 (décembre 2001) : 1190–94. http://dx.doi.org/10.1177/000313480106701216.

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Redo coronary artery bypass grafting (CABG) is characterized by increased patient risk compared with first-time CABG. The reason for higher risk is not completely understood but it is logically related to inadequate myocardial preservation evidenced by the higher incidence of postoperative low-output syndrome. We compared normothermic cardiopulmonary bypass with cold blood maintenance cardioplegia in both first-time and redo CABGs to determine whether this single approach is appropriate for both instances. Five hundred seventeen consecutive CABG patients were retrospectively reviewed. Four hundred fifty-four first-time CABG procedures were compared with 44 redo procedures. All aspects of the operation were identical including myocardial preservation. Retrospective univariant analysis of both groups followed. Three clinical features distinguished first-time versus redo CABG. These were previous percutaneous transluminal coronary angioplasty (first-time 19% vs redo 71%; P < 0.001), preoperative intra-aortic balloon pump (first-time 38% vs redo 71%; P < 0.001), and Parsonnet risk score (first-time 11.7 ± 8.2 vs redo 19.2 ± 8.8; P < 0.001). Operative mortality for redo CABG was higher than in first-time procedures (3.4% vs 6.4%; P = not significant), although small sample size limited statistical significance. The length of stay was statistically longer in redo patients (8.7 ± 10.8 vs 6.0 ± 5.1 days; P < 0.01) and is related to a higher Parsonnet score, increased postoperative pneumonia, and failed percutaneous transluminal coronary angioplasty before redo CABG. We conclude that redo CABG is a different operation from first-time procedures and requires enhanced myocardial preservation. Normothermic cardiopulmonary bypass with cold blood maintenance cardioplegia does not appear to achieve this goal.

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Chaisson, Kristine, Mary Sanford, Richard A. Boss, Bruce J. Leavitt, Michael J. Hearne, Cathy S. Ross, Elaine M. Olmstead et al. « Improving Patients’ Readiness for Coronary Artery Bypass Graft Surgery ». Critical Care Nurse 34, n^o 6 (1 décembre 2014) : 29–36. http://dx.doi.org/10.4037/ccn2014951.

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Background Preoperative interventions improve outcomes for patients after coronary artery bypass surgery (CABG). Objective To reduce mortality for patients undergoing urgent CABG. Methods Eight centers implemented preoperative aspirin and statin, preinduction heart rate less than 80/min, hematocrit greater than 30%, blood sugar less than 150 mg/dL (8.3 mmol/L), and delayed surgery at least 3 days after a myocardial infarction. Data were collected on the last 150 isolated, urgent CABGs at each center (n=1200). A “bundle” score of 0 to 100 was calculated for each patient to represent the percentage of interventions used. Results Scores ranged from 33 to 100. About 56% of patients had a perfect score. Crude mortality and composite rates were lower in patients with higher scores, but once adjusted for patient and disease characteristics, the difference in scores was not significant. Higher scores were associated with shorter intubation: 6.0 hours (score 100), 8.0 hours (score 80–99), 8.4 hours (score<80) (log-rank P<.001). Median length of stay was shorter for patients with higher scores: 5 days (score 100), 6 days (scores 80–99), and 6 days (scores <80) (log-rank P<.001). Conclusion Implementation of interventions to optimize patients’ “readiness for surgery” is associated with shorter intubation times and shorter hospital stays after CABG.

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Torella, Francesco, Sarah L. Haynes, Joanne Bennett, Darreul Sewell et Charles N. Mccollum. « Can Hospital Transfusion Committees Change Transfusion Practice ? » Journal of the Royal Society of Medicine 95, n^o 9 (septembre 2002) : 450–52. http://dx.doi.org/10.1177/014107680209500907.

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Blood and blood products are commonly over-used in hospital practice. We investigated whether the introduction of a red-cell transfusion trigger (haemoglobin <8 g dL–1) influenced transfusion practice in surgery. Coronary artery bypass grafts (CABGs, n=400), total hip replacements (n=107), colectomies (n=85) and transurethral prostatectomies (TURPs, n=158) were reviewed over two periods of six months, before and after the introduction of the policy by the local hospital transfusion committee. After introduction of the policy, the proportion of patients transfused fell from 57% to 45% with CABGs (P=0.02) and from 52% to 26% with hip replacements (P=0.006); for colectomies and TURPs there was no change. Hospital stay did not increase in any of the groups. In the second period, haemoglobin concentration on discharge was lower after total hip replacement, by a mean (95% CI) of 0.7 (0.3–1.2) g dL–1 (P=0.002) and after colectomy, by a mean of 0.6 (0.1–1.1) g dL–1 (P=0.03). Although other factors cannot be excluded, we suggest that the reductions in red-cell transfusion were in large part attributable to the new transfusion policy.

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Yeaton, William H., et Paul M. Wortman. « Medical Technology Assessment ». International Journal of Technology Assessment in Health Care 1, n^o 1 (janvier 1985) : 125–46. http://dx.doi.org/10.1017/s0266462300003780.

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Coronary artery bypass graft surgery (CABGS) has become an important procedure for the treatment of coronary heart disease. Over 100,000 of these surgical procedures are performed each year (1) at an aggregate cost of about $2 billion (2). Despite its current widespread acceptance, this major surgical innovation has generated considerable controversy concerning its effectiveness (3), and there still remains substantial confusion in assessing its overall impact (4).

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Feldman, Leonid, Ilia Beberashvili, Ahmad Abu Tair, Shai Efrati, Oleg Gorelik, Walter G. Wasser, Eitan Heldenberg et Igor Rabin. « Effect of hemodialysis access blood flow on cardiac events after coronary artery bypass grafting using an internal thoracic artery ». Journal of Vascular Access 18, n^o 4 (14 avril 2017) : 301–6. http://dx.doi.org/10.5301/jva.5000693.

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Background The possibility of coronary steal through an arteriovenous fistula (AVF) in hemodialysis (HD) patients with coronary artery bypass grafts (CABGs) using an ipsilateral internal thoracic artery (ITA) has been suggested. In order to define the significance of such a possibility, we analyzed cardiac events and mortality risk in patients in relation to AVF flow. Methods A retrospective cohort study was performed on prevalent HD patients from a single center. The outcomes included a first cardiac event, cardiac death and death from any cause. Results The group consisted of 23 chronic HD patients having ITA CABG and upper extremity AV access, 12 patients had an ipsilateral and 11 patients had a contralateral location of ITA CABG and an upper extremity AV access. The mean follow-up period was for 37.0 months. Multivariable Cox proportional-hazards regression analysis of risk of death from any cause in relation to AV access flow showed no increased risk, neither in the group with ipsilateral location of ITA grafts and dialysis accesses (adjusted HR, 3.047 [95% CI, 0.996 to 1.000], p = 0.081), nor in the group with contralateral location of both shunts (adjusted HR, 0.173 [95% CI, 0.997 to 1.002], p = 0.678). There was no significant correlation between AV access blood flow and the risk of first cardiac event as well as cardiac death in either study group. Conclusions In this study on HD patients having ipsilateral ITA CABG and AVF, fistula flow rate was not found to be associated with mortality or cardiac risk.

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Hsu, Heather E., Alison Tse Kawai, Rui Wang, Maximilian S. Jentzsch, Chanu Rhee, Kelly Horan, Robert Jin, Donald Goldmann et Grace M. Lee. « The Impact of the Medicaid Healthcare-Associated Condition Program on Mediastinitis Following Coronary Artery Bypass Graft ». Infection Control & ; Hospital Epidemiology 39, n^o 6 (19 avril 2018) : 694–700. http://dx.doi.org/10.1017/ice.2018.69.

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OBJECTIVEIn 2012, the Centers for Medicare and Medicaid Services expanded a 2008 program that eliminated additional Medicare payment for mediastinitis following coronary artery bypass graft (CABG) to include Medicaid. We aimed to evaluate the impact of this Medicaid program on mediastinitis rates reported by the National Healthcare Safety Network (NHSN) compared with the rates of a condition not targeted by the program, deep-space surgical site infection (SSI) after knee replacement.DESIGNInterrupted time series with comparison group.METHODSWe included surveillance data from nonfederal acute-care hospitals participating in the NHSN and reporting CABG or knee replacement outcomes from January 2009 through June 2017. We examined the Medicaid program’s impact on NHSN-reported infection rates, adjusting for secular trends. The data analysis used generalized estimating equations with robust sandwich variance estimators.RESULTSDuring the study period, 196 study hospitals reported 273,984 CABGs to the NHSN, resulting in 970 mediastinitis cases (0.35%), and 294 hospitals reported 555,395 knee replacements, with 1,751 resultant deep-space SSIs (0.32%). There was no significant change in incidence of either condition during the study. Mediastinitis models showed no effect of the 2012 Medicaid program on either secular trend during the postprogram versus preprogram periods (P=.70) or an immediate program effect (P=.83). Results were similar in sensitivity analyses when adjusting for hospital characteristics, restricting to hospitals with consistent NHSN reporting or incorporating a program implementation roll-in period. Knee replacement models also showed no program effect.CONCLUSIONSThe 2012 Medicaid program to eliminate additional payments for mediastinitis following CABG had no impact on reported mediastinitis rates.Infect Control Hosp Epidemiol 2018;39:694–700

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Donaldson, H., C. Hughes et J. Lumby. « Pattern of chest wall discomfort after CABGS : Effects of internal mammary artery dissection ». Heart, Lung and Circulation 9, n^o 3 (décembre 2000) : A134. http://dx.doi.org/10.1046/j.1443-9506.2000.07790.x.

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Alshawawreh, Jaser, N. Houli, J. Smith, G. Shardy, J. Goldstein et A. Almeida. « SHA 028. Harmonic scalpel harvesting of conduits in coronary artery bypass surgery (CABGS) ». Journal of the Saudi Heart Association 23, n^o 3 (juillet 2011) : 178–79. http://dx.doi.org/10.1016/j.jsha.2011.02.029.

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Kohsaka, Shun, Hiroaki Miyata, Noboru Motomura, Kazuhito Imanaka, Keiichi Fukuda, Shunei Kyo et Shinichi Takamoto. « Effects of Preoperative β-Blocker Use on Clinical Outcomes after Coronary Artery Bypass Grafting ». Anesthesiology 124, n^o 1 (1 janvier 2016) : 45–55. http://dx.doi.org/10.1097/aln.0000000000000901.

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Abstract Background The authors evaluated the effect of preoperative β-blocker use on early outcomes in patients undergoing coronary artery bypass grafting (CABG) in Japan. Methods The authors analyzed 34,980 cases of isolated CABGs, performed between 2008 and 2011, at the 333 sites recorded in the Japanese Cardiovascular Surgical Database. In addition to the use of multivariate models, a one-to-one matched analysis, based on estimated propensity scores for patients with or without preoperative β-blocker use, was performed. Results The study population (mean age, 68 yr) comprised 20% women, and β-blockers were used in 10,496 patients (30%), who were more likely to have risk factors and comorbidities than patients in whom β-blockers were not used. In the β-blocker and non-β-blocker groups, the crude in-hospital mortality rate was 1.7 versus 2.5%, whereas the composite complication rate was 9.7 versus 11.6%, respectively. However, after adjustment, preoperative β-blocker use was not a predictor of in-hospital mortality (odds ratio, 1.00; 95% CI, 0.82 to 1.21) or complications (odds ratio, 0.99; 95% CI, 0.91 to 1.08). When the outcomes of the two propensity-matched patient groups were compared, differences were not seen in the 30-day operative mortality (1.6 vs. 1.5%, respectively; P = 0.49) or postoperative complication (9.8 vs. 9.7%; P = 1.00) rates. The main findings were broadly consistent in a subgroup analysis of low-risk and high-risk groups. Conclusion In this nationwide registry, the use of preoperative β-blockers did not affect short-term mortality or morbidity in patients undergoing CABG.

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Anderson, Craig. « Perioperative neurocognitive decline following CABGS was persistent and was associated with later cognitive decline ». Evidence-based Cardiovascular Medicine 5, n^o 2 (juin 2001) : 61–62. http://dx.doi.org/10.1054/ebcm.2001.0372.

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Higgs, R. « CABGs and KINGS : relevance and realism in the teaching of clinical ethics in Camberwell. » Journal of Medical Ethics 13, n^o 3 (1 septembre 1987) : 157–59. http://dx.doi.org/10.1136/jme.13.3.157.

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Nobilio, Lucia, et Cristina Ugolini. « Different Regional Organisational Models and the Quality of Health Care : The Case of Coronary Artery Bypass Graft Surgery ». Journal of Health Services Research & ; Policy 8, n^o 1 (janvier 2003) : 25–32. http://dx.doi.org/10.1177/135581960300800107.

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Objectives: The Italian regions of Emilia-Romagna and Lombardy within the Italian National Health Service provide an opportunity to see if two different approaches to the organisation of care – one more hierarchical and planned, the other more competitive and market-like – influence its quality through examining the relationship between the number of coronary artery bypass grafts (CABGs) and the rate of in-hospital mortality using administrative data for the period 1996–1998. Methods: Descriptive statistics and logistic regression models were used. Results: The volume–outcome relation was statistically significant in both regions (odds ratio 0.71, P < 0.0001). Although CABG performance in Emilia-Romagna was slightly poorer than in Lombardy (OR 1.22, P < 0.05), the potential advantage in terms of the reduced risk of death for patients treated at high-volume versus low-volume hospitals was significantly greater. In Emilia-Romagna, the average performance advantage of high-volume units was more substantial in the case of private accredited hospitals than public hospitals (OR = 0.50, P < 0.0001 versus OR = 0.64, P < 0.0001). In Lombardy, the performance advantage of concentrating CABG procedures was greater in private research hospitals (OR = 0.67, P < 0.0001), whereas results were not statistically significant for the other types of hospital, indicating a good level of performance in both public and private hospitals even at low volumes. This also partially explained the lower mortality rate observed in that region. Conclusions: The degree of hierarchical regionalisation versus market-like arrangements characterising the two systems produced contrasting effects in terms of the quality of CABG surgery. Lombardy's more competitive environment appeared to achieve better performance in terms of a slightly lower probability of adverse outcomes, in a system with no formal assessment of population need and very high per capita revascularisation rates. To improve performance in the more hierarchical system adopted in Emilia-Romagna would require considerable effort to increase CABG surgery in low-volume cardiac units, and to sharpen performance incentives.

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Talukder, M. Quamrul Islam. « Total Arterial Coronary Artery Bypass Grafting a review article with short experience in Apollo Hospitals Dhaka ». Pulse 5, n^o 1 (27 août 2014) : 27–29. http://dx.doi.org/10.3329/pulse.v5i1.20186.

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Coronary Artery Bypass Surgery (CABG) is an established surgical treatment of coronary artery disease. Conventionally it has been done with left internal mammary artery and saphenous vein for many years. But the study shows that the rate of stenosis of venous graft is much higher than arterial graft in 10 years after CABG1 Recent studies also proved that the outcome of total arterial grafts for CABG is much better than conventional CABG2 In my recent short practice in this hospital, it also proved to be a safe procedure with better early post operative results. DOI: http://dx.doi.org/10.3329/pulse.v5i1.20186 Pulse Vol.5 January 2011 p.27-29

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Tang, Paul, Shahab Akhter, Satoru Osaki, Lucian Lozonschi, Takushi Kohmoto et Nilto De Oliveira. « Coronary Events in Patients Presenting for Repair of Acute Type A Aortic Dissection ». AORTA 05, n^o 03 (juin 2017) : 71–79. http://dx.doi.org/10.12945/j.aorta.2017.16.058.

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Background: Preoperative coronary angiography is often not performed in acute Type A dissection. We examined differences in the incidence of pre-existing coronary disease and subsequent coronary events between patients undergoing acute Type A dissection repair and patients undergoing elective proximal aortic aneurysm repair. Methods: From 2000 to 2015, there were 154 acute Type A dissection repairs and 457 elective proximal aortic aneurysm repairs. We performed a retrospective review to evaluate preoperative coronary disease and postoperative coronary interventions such as percutaneous coronary intervention (PCI) and coronary bypass grafting (CABG). Results: A total of 31 (20%) dissection patients and 123 (27%) elective surgery patients had preoperative evidence of coronary artery disease (p = 0.094). All elective surgery patients but only six (4%) dissection patients had preoperative coronary catheterization. More CABGs were performed in the elective surgery group (19%) than in the dissection group (3%, p < 0.001). There were no differences in the incidence of prior PCI, CABG, or myocardial infarction between groups. Following dissection repair, four patients required coronary interventions. Of these, two (1.3%) experienced chest pain and underwent PCI at 4.7 and 4.3 months postoperatively, respectively, and another two experienced symptoms and required PCI at 5 and 7 years, respectively. The 30-day and 14-year mortality rates after dissection repair were 13% and 24%, respectively. Although the dissection group had poorer survival than the elective surgery group (p < 0.001), there was no difference in conditional survival after aortic-related deaths over the first year were censored (p = 0.104). Conclusions: Given the low incidence of missed significant coronary disease (1.3%), it is reasonable to perform Type A dissection repair without coronary angiography.

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Comunale, Mark E., Simon C. Body, Catherine Ley, Colleen Koch, Gary Roach, Joseph P. Mathew, Ahvie Herskowitz et Dennis T. Mangano. « The Concordance of Intraoperative Left Ventricular Wall-motion Abnormalities and Electrocardiographic S-T Segment Changes ». Anesthesiology 88, n^o 4 (1 avril 1998) : 945–54. http://dx.doi.org/10.1097/00000542-199804000-00014.

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Background Transesophageal echocardiography (TEE) and Holter electrocardiography (ECG) are used to detect intraoperative ischemia during coronary artery bypass graft surgery (CABG). Concordance of these modalities and sensitivity as indicators of adverse perioperative cardiac outcomes are poorly defined. The authors tried to determine whether routine use of Holter ECG and TEE in patients with CABGs has clinical value in identifying those patients in whom myocardial infarction (MI) is likely to develop. Methods A total of 351 patients with CABG and both ECG- and TEE-evaluable data were examined for the occurrence of ischemia and infarction. The TEE and five-lead Holter ECGs were performed continuously during cardiac surgery. The incidence of MI (creatine kinase-MB > or = 100 ng/ml) within 12 h of arrival in the intensive care [ICU] unit, new ECG Q wave on ICU admission or on the morning of postoperative day 1, or both, were recorded. Results Electrocardiographic or TEE evidence of intraoperative ischemia was present in 126 (36%) patients. The concordance between modalities was poor (positive concordance = 17%; Kappa statistic = 0.13). Myocardial infarction occurred in 62 (17%) patients, and 32 (52%) of them had previous intraoperative ischemia. Of these, 28 (88%) were identified by TEE, whereas 13 (41%) were identified by ECG. Prediction of MI was greater for TEE compared with ECG. Conclusions Wall-motion abnormalities detected by TEE are more common than S-T segment changes detected by ECG, and concordance between the two modalities is low. One half of patients with MI had preceding ECG or TEE ischemia. Logistic regression revealed that TEE is twice as predictive as ECG in identifying patients who have MI.

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Tsai, Y., A. Wilson-O’Brien, S. Bappayya, D. Dinh, D. Reid, H. Rizzoli et A. Newcomb. « BMI is a Significant Predictor of Cost and Resource Utilization in Diabetic Patients Undergoing CABGS ». Heart, Lung and Circulation 20 (janvier 2011) : S223. http://dx.doi.org/10.1016/j.hlc.2011.05.549.

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Parida, Satyen, Pranit Patil, PrasannaUdupi Bidkar, Sakthirajan Panneerselvam et MV S Satyaprakash. « Effect of chloride liberal fluids on renal and metabolic profiles of patients undergoing off-pump CABGs ». Annals of Cardiac Anaesthesia 22, n^o 2 (2019) : 235. http://dx.doi.org/10.4103/aca.aca_223_18.

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Brett, J., A. Bull, C. Boardman, C. Dunkley, L. Worth et M. Richards. « Six Years of Infections Surveillance Following Coronary Artery Bypass Graft Surgery (CABGS) in Victoria—An Overview ». Heart, Lung and Circulation 18 (2009) : S71—S72. http://dx.doi.org/10.1016/j.hlc.2009.05.159.

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Sahasrabudhe, Parag, Ranjit Jagtap, Amit Jadhav, Nikhil Panse, Nilesh Juvekar et Sampada Patwardhan. « Audit of 37 cases of deep sternal wound infections (DSWIs) following 2418 coronary artery bypass graftings (CABGs) ». Indian Journal of Thoracic and Cardiovascular Surgery 32, n^o 2 (27 avril 2016) : 103–12. http://dx.doi.org/10.1007/s12055-016-0425-6.

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Kahl, Carolina, Kamylla Santos da Cunha, Gabriela Marcellino de Melo Lanzoni, Giovana Dorneles Callegaro Higashi, Alacoque Lorenzini Erdmann et Maria Aparecida Baggio. « Referral and counter-referral : repercussions of coronary artery bypass graft in the perspective of Primary Care ». Revista Brasileira de Enfermagem 71, n^o 5 (octobre 2018) : 2359–66. http://dx.doi.org/10.1590/0034-7167-2016-0598.

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ABSTRACT Objective: to understand how repercussions of the referral and counter-referral of patients with indication/submitted to Coronary Artery Bypass Graft Surgery in the context of Primary Health Care. Method: qualitative research with a theoretical-methodological contribution anchored in the Grounded Theory. Theoretical sampling was performed with 41 participants, divided into three sample groups (patients, health professionals and managers) in the Metropolitan Region and Western Region of Santa Catarina State. Results: the need for improvement in the process of recording clinical data in the regulation system emerged to strengthen patient referral; and the absence of a formal process of counter-referral and adaptation of lifestyle with repercussion in the counter-referral. Final considerations: the repercussions of the referral and counter-referral of patients with indication/submitted to the CABGS in the context of Primary Care are experienced through professional guidance and, in particular, by family support.

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Wortman, Paul M., et William H. Yeaton. « Using Research Synthesis in Medical Technology Assessment ». International Journal of Technology Assessment in Health Care 3, n^o 4 (octobre 1987) : 509–22. http://dx.doi.org/10.1017/s0266462300011144.

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AbstractThis article describes the use of research synthesis procedures (e.g., meta-analysis) in evaluating medical technologies. The synthesis process involves retrieval, extraction, and analysis of pertinent information from a set of research studies. There are several advantages of research synthesis: determining overall effectiveness, explaining seemingly contradictory findings, providing a standard measure of effect, and increasing statistical power. In addition, such syntheses provide timely results that can assist various policy decisions such as initiating clinical trials at NIH, reimbursement at HCFA, and answering NIH consensus conference questions. The authors' synthesis of the research literature on coronary artery bypass graft surgery (CABGS) illustrates how this method can address the various elements of a technology assessment such as safety, efficacy, and cost-effectiveness. The paper concludes by noting how research synthesis can be particularly advantageous in assessing technologies that are rapidly evolving (e.g., lytic agents for acute myocardial infarction).

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Malaiapan, Yuvaraj R., Michael Leung, Brian Ko, Wai-ee Thai et Ian T. Meredith. « IVUS GUIDED MANAGEMENT OF ANGIOGRAPHIC INTERMEDIATE CORONARY LESIONS : LONG TERM OUTCOME AFTER REFERRAL TO PCI, CABGS OR MEDICAL THERAPY ». Journal of the American College of Cardiology 57, n^o 14 (avril 2011) : E1851. http://dx.doi.org/10.1016/s0735-1097(11)61851-2.

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Rihal, Charanjit S. « Stenting offered similar rates of death, stroke, and MI at a lower cost, but with more repeat revascularizations compared with CABGS ». Evidence-based Cardiovascular Medicine 5, n^o 2 (juin 2001) : 53–55. http://dx.doi.org/10.1054/ebcm.2001.0361.

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Tivendale, Lynda, Rochelle Wynne, Shan Shan Law, Louise Kenny, Gray Dean et James Tatoulis. « Effect of External Compression Bandage on Forearm Swelling, Discomfort, and Pain Following the Removal of a Radial Artery Conduit for CABGS ». Chest 140, n^o 4 (octobre 2011) : 506A. http://dx.doi.org/10.1378/chest.1119051.

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NUÑEZ, G. G., S. N. COSTANTINO et S. M. VENTURIELLO. « Immunoparasitological parameters of the intestinal phase of trichinellosis in rats ». Parasitology 126, n^o 4 (avril 2003) : 321–25. http://dx.doi.org/10.1017/s0031182003003007.

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Enzyme-linked immunosorbent assays (ELISAs) were developed in order to detect coproantigens (CAgs), coproantibodies (CAbs) and faecal immune complexes (FIC) in rats experimentally infected with Trichinella spiralis. The usefulness of these assays was compared to that of a conventional ELISA for detection of serum antibodies (Abs) to muscle larvae excretory–secretory products (ML–ESP). The ELISA for CAgs was the first parameter to give a positive result but the detection was limited only to day 2 p.i. CAbs against ML–ESP and adult worm excretory–secretory products (AW–ESP) was first positive on day 4 p.i. Anti-ML–ESP remained positive until day 12 p.i. while CAbs against AW–ESP remained positive throughout the study period. Specific IgE and IgA were found. FIC were detected between days 2 and 8 p.i. Serum Abs began to appear on day 10 p.i. Therefore, the ELISA for CAbs was a suitable assay for the detection of the enteral and early phases of the infection.

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Rihal, Charanjit S. « PTCA yielded a similar risk of death, but greater risks of MI and revascularization over 5 years compared with CABGS for isolated LAD stenosis ». Evidence-based Cardiovascular Medicine 3, n^o 4 (décembre 1999) : 102–3. http://dx.doi.org/10.1054/ebcm.1999.0252.

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Bezanson, Judy L., Ora L. Strickland, Marguerite R. Kinney et William S. Weintraub. « Assessing Data Adequacy for Clinical Research : Reliability and Validity of a Surgical Database ». Journal of Nursing Measurement 10, n^o 2 (septembre 2002) : 155–64. http://dx.doi.org/10.1891/jnum.10.2.155.52556.

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As clinical databases are utilized more frequently for clinical research, it is essential that researchers assess the quality of databased information. While researchers have begun to report strategies to measure accuracy of databased information, knowledge remains limited. The purpose of this study was to assess the reliability and validity of databased information among selected study variables contained within a computerized coronary artery surgery clinical database using the written patient medical record as an external standard. Both reliability (N= 400) and validity (N= 100) samples were randomly selected from a databased sampling frame of 548 Medicare subjects who underwent coronary artery bypass grafting surgery in 1998. Reliability assessed by consistency rates were age (95%), race (94%), gender (99%), congestive heart failure (CHF) (60.5%), angina (91.5%), renal insufficiency (82%), hypertension (91.7%), diabetes mellitus (93.7%), chronic obstructive pulmonary disease (COPD) (75.5%), clinical status (97%), American Society of Anesthesiologists classification (99%), prior peripheral vascular surgery (15.5%), prior CABGS (99%), and duration of mechanical ventilation (87.5%). These percentages reflected a large portion of missing data for CHF, COPD, and prior peripheral vascular surgery. Validity assessed by sensitivity and specificity analyses were all greater than 80%. The majority of computerized databased information among selected study variables was the same information recorded in the written patient medical record. Using the same external standard to assess both reliability and validity was a significant limitation of this study, which resulted in the same measure of data adequacy by utilizing differing statistical methods.

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&NA;. « HOME-BASED EXERCISE (HBE) PROMOTES SUSTAINED CHANGES IN PHYSICAL AND PSYCHOSOCIAL OUTCOMES COMPARED TO INSTITUTION-BASED EXERCISE (IBE) FOLLOWING CORONARY ARTERY BYPASS GRAFT SURGERY (CABGS) ». Journal of Cardiopulmonary Rehabilitation 21, n^o 5 (septembre 2001) : 327. http://dx.doi.org/10.1097/00008483-200109000-00026.

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Lehot, Jean-Jacques, Pascale Blanc, Helene Bouvier, Claude Girard et Michel Ovize. « Room C, 10/17/2000 2 : 00 PM - 4 : 00 PM (PS) Oral Treatment with Nicorandil(N) Prior to Coronary Artery Bypass Graft Surgery (CABGS) ». Anesthesiology 93, n^o 3A (1 septembre 2000) : A—221. http://dx.doi.org/10.1097/00000542-200009001-00221.

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Kunz, Stephen, Kelly Mirowska-Allen, Damian Ianno et Siven Seevanayagam. « Bad Blood - A 5-Year Review of Transfusions Associated With CABGs and Single Valve Repairs at a Tertiary Cardiac Centre, and Their Compliance With National Guidelines ». Heart, Lung and Circulation 26 (2017) : S375. http://dx.doi.org/10.1016/j.hlc.2017.03.066.

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Taha, Abdulsalam Yaseen, Shkar Raouf Haji Saed, Amanj Kamal Mohammed et Jivara Hama Nadr. « Mitral valve surgery : comparison between superior septal and left atrial approaches ». Journal of the Faculty of Medicine Baghdad 62, n^o 4 (21 février 2021) : 92–98. http://dx.doi.org/10.32007/jfacmedbagdad.6241810.

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Background Mitral valve (MV) is one of the most complex structures in human heart with a challenging exposure. Traditionally, MV is approached via left atriotomy (LAA) while superior septal approach (SSA) is an alternative.Objective: is to highlight the merits and demerits of these two approaches in providing access to the MV in term of the aortic cross clamp time (ACCT), quality of exposure, and potential complications in view of the published literature. Patients and Method: Over an 18-month period ending at June 30th, 2019, 56 patients with MV disease ± other cardiac diseases were enrolled in this study. Twenty patients had surgery via LAA (one surgeon) whereas 36 were operated upon via SSA (another surgeon). Standard surgery was done via median sternotomy, cardiopulmonary bypass and hypothermia of 32 0C. Perioperative events were recorded. Results In SSA group (males=25; age ranged 23-74 years; mean=57.4), patients had chest pain and breathlessness for a mean of 3 months (>LAA) besides low ejection fraction (EF) in 44%, atrial fibrillation (AF) in 38.9% and dilated LA in 19.4%. They underwent 25 MV replacements (MVR), 11 MV repairs (0 in LAA), 11 coronary artery bypass grafts (CABGs) (2.6 graft per patient vs. 1.3 in LAA; significant) and 2 aortic valve replacement. Mean ACCT was 81.6 minutes (˂LAA). Postoperatively, 32 patients (88.9%) had a normal or improved EF, 11 of 14 AF patients (78.6%) reverted to sinus rhythm and no hospital death was recorded. Conclusion Besides excellent exposure, the SSA enabled us to perform MVR or repair ± additional interventions within a short time and without a heart block. Hence, our results matched the international literature.

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Piatkowski, Radoslaw, Janusz Kochanowski, Monika Budnik, Michal Peller, Marcin Grabowski et Grzegorz Opolski. « Stress Echocardiography Protocol for Deciding Type of Surgery in Ischemic Mitral Regurgitation : Predictors of Mitral Regurgitation Recurrence following CABG Alone ». Journal of Clinical Medicine 10, n^o 21 (20 octobre 2021) : 4816. http://dx.doi.org/10.3390/jcm10214816.

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Purpose: Although coronary artery bypass grafting alone (CABGa), or, with mitral annuloplasty (CABGmp), is considered the best therapeutic strategy for patients with ischemic mitral regurgitation (IMR), some recurrences are still reported. The aim of this study was to evaluate the use of the mitral deformation indices (MDI) as a predictor of recurrence of mitral regurgitation in a 12-month follow-up after CABG alone. Methods: A total of 145 patients after myocardial infarction with significant IMR, eligible for CABG, were prospectively enrolled in the study. Mitral valve morphology, left ventricle function, IMR degree as assessed by effective regurgitation orifice area (ERO), myocardial viability, and MDI were assessed prior to surgery. Patients were referred for CABGa (gr.1; n = 90) or CABGmp (gr.2; n = 55) based on clinical assessment, and the results of rest and stress echocardiography (exercise echocardiography and low dose dobutamine echocardiography-DBX). One year after surgery, each patient underwent the evaluation of cardiovascular events. Univariable logistic regression analysis was used to identify the factors of recurrence of IMR in 1 year follow-up. Serial echo examinations were performed in all patients at discharge, and at 1 and 12 months after surgery. Results: Logistic regression analysis revealed that in CABGa, group preoperative changes of tenting area (TA) and coaptation high (CH) during DBX remained the predictors of the recurrence of IMR in 12 months follow-up. TAdbx > 1 cm2 provided a sensitivity of 90% and specificity of 29%, (AUC 0.6436). The best cut-off value for CHdbx was 0.4 cm (sensitivity 90%, specificity 34%; AUC 0.6432). In both groups (CABGa vs. CABGmp) no significant differences were observed in 12-month mortality (1.2% vs. 0%; p = 1.0), hospitalizations due to the heart failure (HF) exacerbation (5.9% vs. 8.5%; p = 0.72), and in the incidence of the composite endpoint (deaths/CV hosp/stroke) (7% vs. 8.5%; p = 0.742). Conclusions: The preoperative assessment of MDI changes during dbx can be used to identify patients with IMR qualified to CABG alone at increased risk of recurrence of IMR in 1 year follow-up. Mitral deformation analysis should be used for a better qualification of patients with IMR to the exact surgical approach.

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NUÑEZ, G. G., S. N. COSTANTINO et S. M. VENTURIELLO. « Detection of coproantibodies and faecal immune complexes in human trichinellosis ». Parasitology 134, n^o 5 (mai 2006) : 723–27. http://dx.doi.org/10.1017/s0031182006001983.

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SUMMARYTrichinella spiralisis the nematode causative agent of trichinellosis, an intestinal and tissular parasitosis. Even though an early diagnosis during the intestinal phase is essential to limit the infection in humans, to date, there are no available tests to achieve this goal. Based on the immune response generated by the host's intestinal mucosa, the aim of this work was to develop ELISAs to assess the presence of coproantigens (CAgs), coproantibodies (CAbs) and faecal immune complexes in stool samples of 18 individuals belonging to different outbreaks that have arisen in Argentina. By the methodologies developed in this work it was found that anti-muscle larva excretory-secretory products (ML-ESP) CAbs were detected in 89% of the samples analysed regardless of the time p.i. Anti-ML-ESP IgA, IgG, IgE and IgM were detected in 56%, 56%, 28% and 22% of the individuals respectively. Those samples negative for anti-ML-ESP total immunoglobulins proved positive for anti-adult worm-ESP CAbs. No CAgs were detected in any of the samples. The results obtained in this work indicate that the intestinal immune response in human trichinellosis is featured by all the isotypes of specific immunoglobulins. Furthermore, the detection of antibodies in stool samples, in either the free or complexed form, could be applied to confirm early human trichinellosis.

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Sreekumar, Pradeep, Sunil Pisharody, Rajagopal Retnakaran, Ashish Indai, Poonam Bhutada et Somanathan C. « Complex coronary intervention outcomes : real world left main coronary artery angioplasty experience from a tertiary care center in South India ». International Journal of Advances in Medicine 6, n^o 4 (24 juillet 2019) : 1157. http://dx.doi.org/10.18203/2349-3933.ijam20193264.

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Background: Left Main Coronary Artery (LMCA) Disease is among the most complex forms of the coronary artery stenosis, the leading cause of mortality in the world.Methods: In this analysis, 102 patients with elective angioplasty for LMCA stenosis with PCI from 6/2013 to 5/2016, 3 years (70 in GenxSync™ arm and 32 in other devices arm; 100 DES and 2 BMS) were included. RADHIKa Analysis compared post-hoc subgroups of GenxSync™ and control groups.Results: Mean population age was 59.99±12.03 years; 60.27±10.49 years in GenxSync™ arm, and 58.31±14.32 years in control arm. A significant population (44, 43.14%) had diabetes, renal impairment (14, 13.73%) and hypertension (25, 24.51%). The MACCE in GenxSync™ arm was 17 13(18.58%) Versus 5(15.63%) [RR=0.93, RR’=-0.07, ψ=-14.01. p=0.3). Most patients presented with unstable Angina (41, 40.20%) in all, 31(44.29%) in GenxSync™ and 10 (31.25%) in Control arm. AWMI and IWMI were 18, 17.65% each, attributed to 12 (17.14%) in GenxSync™ 6 (18.75%) in Control. Effort angina was 15(21.43%) in GenxSync™ and 10 (31.25%) in Control and NSTEMI was 25,24.51% (18 (25.71%)- GenxSync™ 7(21.88%) Control). The MACE in GenxSync™ arm at 24, 12 and 6 months was 12(17.15%), 8(11.43%) and 4(5.71%) respectively versus corresponding MACE in the control arm as 5(15.63%), 2(2.86%) and 2(6.25%) respectively. The TVR was present only in GenxSync™ Arm, which was contributed by 2 CABGs and 12 months and 1 additional PCI at 24 months.Conclusions: In real-world scenario of LMCA cases, performance and safety of various stents were similar. GenxSync™ Sirolimus Eluting Stent, in the post-hoc bifurcation had results similar to other real-world cases, based upon RADHIKa analysis.

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Ianno, Damian, Kelly Mirowska-Allen, Stephen Kunz et Siven Seevanayagam. « There Will Be Blood : A 5-Year Review of Transfusions Associated With CABGs and Single Valve Repairs at a Tertiary Cardiac Centre, and Their Impact on Patient Hospital Length of Stay ». Heart, Lung and Circulation 26 (2017) : S371—S372. http://dx.doi.org/10.1016/j.hlc.2017.03.056.

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Jayananda, Amin Dhanush, Sujata Patnaik, Amaresh Rao et S. Rammurti. « Role of MDCT in Assessment of Long-term Graft Patency in Female Patients ». Indian Journal of Cardiovascular Disease in Women 7 (17 décembre 2022) : 188–94. http://dx.doi.org/10.25259/mm_ijcdw_475.

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Objectives: The aim of the study was to analyze the utility of CT-coronary angiogram (CT-CAG) in assessment of long-term graft patency compared to conventional invasive coronary angiography (ICA) and highlight any gender-specific issues in female post-coronary artery bypass surgery (CABG) patients. Materials and Methods: The medical records and images of 30 patients including four female patients who had CABG in the past and underwent both conventional and CT-CAGs were analyzed retrospectively. Results: We studied 30 patients who had CABG in whom both CT-CAG and conventional coronary angiograms were performed. CT-CAG was able to evaluate the grafts better than ICA and was useful even in those which could not be assessed due to technical failure by ICA. There were only four female patients in this series. In first patient, the arterial graft (left internal mammary artery [LIMA]) was patent but distal run off was absent in LAD in CT-CAG images and was reported as poor in conventional coronary angiogram. The second patient had CABG 10 years back. The arterial graft (LIMA) to LAD was patent and there was total block in SVG graft to RCA at proximal anastomotic site. The third patient with hypertension and diabetes also had CABG 10 years back. Both LIMA to LAD and SVG to PDA were patent in her. In last case who had CABG 7 years, two of the three SVG grafts were blocked which were well-demonstrated on CT CAG, including one SVG missed on conventional CAG. Conclusion: CT-CAG is a non-invasive and less cumbersome alternative to conventional CAG for the assessment of grafts long after CABG even in women. The data generated by CT-CAG in post-CABG are as good as the invasive CAG and it has distinct advantage of greater acceptability.

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Ewers, Tola, Babak Aryanfar, Marvin J. Bittner, Erin C. Balkenende, Suzanne F. Bradley, Madisen Brown, Matthew B. Goetz et al. « 885. Feasibility of Observing Traffic Patterns (FOOT Patter) in Veterans Health Administration Operating Rooms ». Open Forum Infectious Diseases 7, Supplement_1 (1 octobre 2020) : S478. http://dx.doi.org/10.1093/ofid/ofaa439.1073.

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Abstract Background Surgical site infections (SSIs) complicate nearly 6% of surgeries performed in Veterans Health Administration (VA) hospitals and occur despite adoption of practices known to reduce them. SSIs are associated with prolonged hospitalization and an increased risk of readmission, reoperation and mortality. Operating room (OR) door openings may increase SSI through disruption of desired OR air flow patterns and increased wound microbe counts. Our study objectives were to: 1) develop a methodological approach for collecting data on entry/exit traffic patterns in VA ORs and 2) characterize patterns across different surgery types. Methods Trained researchers from 10 VA-Centers for Disease Control and Prevention (CDC) Practice-based Research Network sites observed staff entering and exiting VA ORs. Staff were categorized and identified by role. Exits/entries were recorded on a standardized tracking sheet. Surgery type and observation duration from incision to closure were noted. Mean hourly door openings across procedure and role types were compared via a one-way ANOVA using Stata ver. 15.0. Results We observed 56 surgeries on 55 patients (Fig. 1). During 9,801 observation minutes, 766 staff opened doors 3,882 times. Door openings by role differed significantly (p < 0.001) with nurses, perfusionists, anesthesia and vendors having the highest mean door-opening rate. Coronary artery bypass grafts (CABGs) accounted for most door openings and significantly greater surgical duration than other procedures (p=0.012). Time-adjusted OR door opening rate was similar across procedure types at ~22-26 hourly openings (p=0.186). Figure 1. FOOT Patter results Conclusion The hourly rate of door openings varied notably by staff role. Our data show that measurement of OR movements is feasible although gaining access and approval to observe, achieving ideal observer positioning in complex floor plans, and potential misidentification of entering/exiting staff are challenges of direct methods. Scaling this study up may require automated processes. Studies exploring influences of traffic patterns on OR air quality metrics and impact on risk of SSI, identifying rationale and necessity for door openings and effective strategies for reducing unneeded door openings are needed. Disclosures All Authors: No reported disclosures

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