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At least 19 recordsLinked to original sources
PubMed1999

Extended use of arterial conduits for myocardial revascularization.

Myocardial revascularization by means of surgical coronary artery bypass grafting has proven to provide reproducible and durable relief from the sequellae of coronary atherosclerosis. Despite the proven success of this operation, efforts are ongoing both to reduce the perioperative risks and morbidity, as well as to improve the long-term outcomes. The use of multiple arterial conduits is an example of the latter. This is based on the proven superior long-term patency of arterial grafts as compared with venous conduits. A remarkable wide variety of conduits and configurations are being explored currently. We outline our current thinking with regard to arterial grafting as the field now stands. The early results are encouraging, and suggest a significant improvement in long-term relief from angina pectoris and freedom from reintervention when multiple arterial conduits are employed.

Coronary Artery Bypass↗
PubMed1993

Emergency myocardial revascularization for myocardial infarction evolving outside the hospital. A feasible option when thrombolysis and coronary angioplasty have failed.

Most reports on emergency coronary revascularization deal with failed percutaneous transluminal coronary angioplasty (PTCA) or refractory ischemia which developed after hospital admission. The objective of this study was to evaluate the feasibility and prognosis of emergency revascularization for acute myocardial infarction evolving outside the hospital. Between 1974 and 1992 54 cases were included in this study. The patients had both electrocardiographic and clinical evidence of ongoing ischemia. One or more infarct-related obstructed coronary arteries were documented by emergency angiography. Since 1981, the patients have been given urokinase, and, since 1986, they have undergone PTCA initially and, when reperfusion failed, revascularization was started. Overall in-hospital mortality has been 11.1% (6/54). All other patients were discharged in satisfactory condition. Follow-up for periods of up to nearly twenty years has been uneventful with the exception of two late sudden deaths. The above results confirm that emergency coronary revascularization is a therapeutical option worth considering.

Adult↗
PubMed1996

[Minimally invasive myocardial revascularization. Initial experience with myocardial revascularization without extracorporeal circulation].

The authors present an account on the first phase of application of minimally invasive techniques of revascularization of the heart into clinical practice at their department. Since December 1994 to the end of January 1995 in selected 15 patients from a total of 240 patients with IHD 16 arterial and 8 venous grafts were sutured on the beating heart from median sternotomy. None of the patients died and none need reoperation. All patients are free from anginous complaints after operation and their clinical condition is satisfactory. Revascularization of the heart by means of arterial and venous grafts on the beating heart from median sternotomy is a technically reproducible method which enables us to elaborate further minimally invasive procedures for the treatment of IHD. The presented paper is a preliminary communication without claims of statistical validity of the achieved results.

Aged↗
PubMed2000

Emergency myocardial revascularization for acute myocardial infarction: survival benefits of avoiding cardiopulmonary bypass.

OBJECTIVE: Emergency coronary artery bypass grafting (CABG) for acute myocardial infarction (AMI) is associated with increased operative mortality. It has been suggested that this mortality might be reduced by performing the operation without cardiopulmonary bypass (CPB). METHODS: Between January 1992 and April 1998, 77 patients underwent emergency CABG within 48 h of AMI. Thirty seven were operated on with CPB, and 40 without CPB. The two groups were similar regarding age, gender, left-ventricular ejection fraction (EF) and preoperative use of intra-aortic balloon pump (IABP; 50%). The mean number of grafts/patient was 3 in the CPB group, and 1.9 in the No-CPB group (P<0.0001). RESULTS: Operative mortality in the CPB group was 24% (nine of 37) compared to 5% (two of 40) without CPB (P=0.015). Follow-up ranged between 6 and 66 months. There were no late deaths in the CPB group compared to nine (22%) in the No-CPB group (P<0.0066). Patients operated on with CPB had lower rates of recurrent angina (0 versus 15%; P=0.04) and re-interventions (0 versus 15%; P=0.04). CONCLUSIONS: Our experience suggests that CABG without CPB is the preferred method of myocardial revascularization, due to the fact that it carries lower mortality than CABG with CPB. The trade-off includes increased rates of recurrent angina, re-interventions and late mortality.

Aged↗
PubMed1976

Myocardial revascularization after acute myocardial infarction.

Revascularization of the myocardium was performed in 25 patients two to eight hours after acute myocardial infarction (MI). The intra-aortic balloon pump was used in 11 patients. Thirteen patients received revascularization within four hours of onset of MI; all survived the operation. Seven patients were studied postoperatively; ten of 12 grafts (83%) were patent. There was a considerable decrease in left ventricular (LV) dyskinesis and an improvement in LV function. Among 12 patients in whom revascularization was performed for more than four hours' duration after the onset of MI, ten survived. Six were studied postoperatively; six of nine grafts (66%) were patent. There was an increase in LV dyskinesis, with deterioration in LV function. In three patients, ECG evidence of Q wave persisted in spite of absence of dyskinesis postoperatively. The interval during which revascularization of acute infarction produces acceptable results in less than four hours.

Adult↗
PubMed2000

Acute changes of global and regional left ventricular function immediately after direct myocardial revascularization.

Direct myocardial revascularization (DMR) has been proposed to treat patients with severe coronary artery disease who are not amenable for classical revascularization techniques such as percutaneous coronary intervention (PCI) or bypass surgery (CABG). Although recent reports suggest its benefit in alleviating patients' complaints in the long term, there is still a paucity of data on the immediate impact on regional and global myocardial functioning following this treatment. In this overview we discuss our own experience and provide a summary of other data currently available.

Coronary Disease↗
PubMed1998

Current perspectives on direct myocardial revascularization.

Direct myocardial revascularization (DMR), either surgical or catheter-based, uses lasers to create channels between ischemic myocardium and the left ventricular cavity to improve perfusion and decrease angina. This technique can also be used to deliver drugs to the damaged tissue. Candidates include patients with chronic, severe, refractory angina and those unable to undergo conventional surgical revascularization or angioplasty because remaining conduits or acceptable target vessels are lacking. Although the mechanism of action of DMR is still not known, several theories have been proposed, including stimulated angiogenesis. Late sequelae also remain to be determined. Channel characteristics differ depending on whether they were created by carbon dioxide or holmium/yttrium-aluminum-garnet (Ho: YAG) lasers. Catheter-based DMR obviates thoracotomy and anesthesia and, in systems that can create electromechanical maps, fluoroscopy. Phase I clinical trials are now under way to evaluate catheter-based DMR, with endpoints that include improvement in symptoms of angina, exercise capacity, and radionuclide myocardial perfusion.

Cardiac Catheterization↗
PubMed2003

Myocardial revascularization for acute myocardial infarction: benefits and drawbacks of avoiding cardiopulmonary bypass.

BACKGROUND: Coronary artery bypass grafting (CABG) for acute myocardial infarction (AMI) is associated with increased mortality compared with CABG in non-AMI patients. Operating without cardiopulmonary bypass (CPB) might reduce this mortality. METHODS: Between January 1992 and December 1998, 225 patients underwent CABG within 7 days of AMI, 119 with CPB and 106 without. The two groups were similar regarding age, gender, left ventricular dysfunction, and incidence of cardiogenic shock. Mean number of grafts per patient was 3.1 in the CPB group, and 1.7 in the no-CPB group (p < 0.0001). RESULTS: Operative mortality in the CPB group was 12% compared with 3.8% without CPB (p = 0.027). Independent predictors of operative mortality were preoperative use of intraaortic balloon counterpulsation (IABP), nonuse of internal thoracic artery (ITA) to the left anerior descending artery, and the use of less than three grafts. Mortality of patients operated on with CPB within 48 hours of AMI was significantly higher (16.5% vs 4.3%, respectively; p = 0.044). However, patients operated on after 48 hours had similar mortality (5.8% vs 3.4%, respectively). Follow-up ranged from 6 to 84 months. Five-year survival (Kaplan-Meier) of both groups was similar (81%). Patients operated on with CPB had similar rates of recurrent angina; however, they had lower prevalence of reinterventions (0.8% vs 6.3%; p = 0.03). CONCLUSIONS: Our study suggests that CPB can be used safely for most patients referred for CABG within the first week of AMI. However, for emergency patients operated on within the first 48 hours of symptom onset, we advocate avoiding CPB because it is associated with lower operative mortality.

Aged↗
PubMed1993

[Myocardial revascularization in silent myocardial ischemia].

Although there have been many reports of medical treatment of silent myocardial ischaemia (SMI) there have been fewer studies on the effects of myocardial revascularisation for this form of ischaemia. Myocardial revascularisation by coronary bypass surgery is particularly beneficial in patients with triple vessel disease and poor ventricular function, as shown by Weiner in a subgroup of patients from the CASS study. The tendency nowadays is to offer percutaneous transluminal coronary angioplasty (PTCA), because it is less traumatic, relatively simple and effective. A review of the literature shows that SMI may be treated effectively by PTCA. In a personal series of 62 patients, 80% of those are still asymptomatic and have no signs of ischaemia on maximal negative exercise stress tests one year after the procedure.

Angioplasty, Balloon, Coronary↗
PubMed1993

Experimental studies of laser myocardial revascularization in rats.

Myocardial revascularization by Nd: YAG laser used in rats with myocardial infarction was studied. The left coronary artery was ligated and the laser channels with a diameter of 300 microns were made immediately by 2.5-4.2 W lasersonics YAG unit. After 24 hours, the rats were killed. Evaluation included hemodynamics, lactate dehydrogenase of myocardium and myocardial infarct size. The results showed that laser myocardial revascularization reduced myocardial infarct size and enzyme leakage, and improved left ventricular function. The study may provide theoretical basis for the clinical applications of this new technique in the treatment of ischemic heart disease.

Animals↗
PubMed1993

Retrograde versus antegrade delivery of cardioplegic solution in myocardial revascularization. A clinical trial in patients with three-vessel coronary artery disease who underwent myocardial revascularization with extensive use of the internal mammary artery.

The effects of retrograde and antegrade delivery of cardioplegic solution on myocardial function were evaluated and compared in 60 patients who underwent myocardial revascularization. All patients had three-vessel coronary artery disease, and the revascularization was done with extensive use of the internal mammary artery. Seventy-five percent of the distal anastomoses were performed with the internal mammary artery. Myocardial protection consisted of St. Thomas' Hospital cardioplegic solution, topical slushed ice, and systemic hypothermia (28 degrees C). The patients were randomly separated into two groups: group A (n = 30), who received antegrade cardioplegia, and group B (n = 30), who received retrograde cardioplegia. With the exception of the total dose of cardioplegic solution (p = 0.02), there was no significant difference between the two groups that concerned septal myocardial temperature at the moment of asystole and after infusion of the total dose of cardioplegic solution. Cardiac function was assessed before and after the patient was weaned from cardiopulmonary bypass. In the immediate postoperative period there was a significant increase in right atrial pressure of the patients who underwent antegrade cardioplegia. For the other registered parameters there was no significant difference either in the immediate postoperative period or 6 hours later. Release of creatine kinase MB isoenzyme was the same in the two groups. Clinical outcome in terms of mortality, prevalence of perioperative infarction, prevalence of low cardiac output, and rhythm and conduction disturbances was similar in both groups. Technical problems related to cannulation and decannulation of the coronary sinus were not encountered. Multivariate analysis showed that occlusion of the left anterior descending coronary artery (p = 0.012) is an essential contraindication of antegrade delivery of cardioplegic solution. Analysis of the patients with an occlusion of the left anterior descending coronary artery who underwent antegrade (n = 9) and retrograde (n = 10) cardioplegia showed a significant difference in the total dose of cardioplegic solution (p = 0.02) and septal myocardial temperature at the moment of asystole (p = 0.008) and after infusion of the total dose of cardioplegic solution (p = 0.015). The mean arterial systolic blood pressure in the antegrade group was significantly lower than in the retrograde group (p = 0.003). Preservation of the left ventricular stroke work index was significantly better in the retrograde group (namely, 85% of its initial value versus 71% in the antegrade group, p = 0.0116).(ABSTRACT TRUNCATED AT 400 WORDS)

Bicarbonates↗
PubMed2004

Myocardial revascularization for acute myocardial infarction.

UNLABELLED: Coronary artery bypass grafting (CABG) for acute myocardial infarction (AMI) is associated with increased morbidity and mortality compared with CABG in non-AMI patients. We describe the surgical results of these high-risk patients. Sixteen patients (nine male and seven female) underwent CABG after recent onset of acute myocardial infarction. The mean age was 64.7 (range: 51 to 78). Seven patients (43.8%) had at least one myocardial infarction in the past, three (18.8%)--diabetes mellitus, two (12.5%)--chronic renal failure after nephrectomy. Five patients (31.3%) were preoperatively in cardiogenic shock, and six patients (37.5%) required preoperative intraaortic balloon pump (IABP) for stabilization. Two patients (12.5%) had postinfarction ventricular septum perforation (VSD) and three patients (18.8%) hed left main artery trunk stenosis. Mean ejection fraction was 46%. During the first 24 hours six patients were operated, during the second day two, up to the seventh day five more and last three between 8th and 21st day after AMI. The operations were performed with extracorporal circulation in middle hypothermia (34 degrees C). The mean number of grafts per patient was 2.9, and the left internal thoracic artery was used in 11 patients (68.8%). In two patients VSD was closed with Dacron patch. All the patients needed longer time of reperfusion and inotropic drugs and eight (50%) of them mechanical support (IABP) during weaning from cardiopulmonary bypass. Three patients (18.8%) died (both with VSD) because of low output syndrome and multiorgan failure, all were over 70 years old (72, 73, 78). CONCLUSION: emergency coronary artery bypass grafting for acute myocardial infarction is associated with increased operative mortality and morbidity especially in the first 48 hours. The only risk factors for postoperative mortality in this group of patients are age over 70 years, cardiogenic shock, left main artery stenosis and the shortness of the interval between acute myocardial infarction onset and surgery.

Aged↗