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Obstructive sleep apnea is common among patients referred for coronary artery bypass grafting and can be diagnosed by portable monitoring

Danzi-Soares, Naury de Jesus; Genta, Pedro Rodrigues; Nerbass, Flavia Baggio; Pedrosa, Rodrigo Pinto; Nunes Soares, Flavia Souza; Machado Cesar, Luis Antonio; Drager, Luciano F.; Skomro, Robert; Lorenzi-Filho, Geraldo
Fonte: LIPPINCOTT WILLIAMS & WILKINS; PHILADELPHIA Publicador: LIPPINCOTT WILLIAMS & WILKINS; PHILADELPHIA
Tipo: Artigo de Revista Científica
ENG
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126.5%
Background Obstructive sleep apnea (OSA) is common among patients with coronary artery disease. However, OSA remains largely under recognized. The lack of clinical suspicion and difficulties to access full polysomnography (PSG) are limiting factors. The aim of this study was to evaluate, among patients referred to coronary artery bypass grafting (CABG): (i) the prevalence of OSA, (ii) the association of OSA with clinical symptoms, (iii) the performance of overnight unattended portable monitoring (PM) as an alternative method for the diagnosis of OSA. Methods Consecutive patients referred for CABG were evaluated by standard physical evaluation and validated questionnaires (Berlin questionnaire and Epworth Sleepiness Scale) and underwent full PSG and PM (Stardust II). Results We studied 70 consecutive patients (76% men), age 58 +/- 7 years (mean +/- SD), BMI [median (interquartile range)] 27.6 kg/m(2) (25.8-31.1). The prevalence of OSA (full PSG) using an apnea-hypopnea index of at least 5 events/h was 87%. Commonly used clinical traits for the screening of OSA such as the Epworth Sleepiness Scale and neck circumference had low sensitivities to detect OSA. In contrast, the Berlin questionnaire showed a good sensitivity (72%) to detect OSA. PM showed good sensitivity (92%) and specificity (67%) for the diagnosis of OSA. Conclusion OSA is strikingly common among patients referred for CABG. The Berlin questionnaire...

Influence of Pleural Drain Insertion in Lung Function of Patients Undergoing Coronary Artery Bypass Grafting

Carvalho Ozelami Vieira, Irinea Beatriz; Vieira, Fabiano F.; Abrao, Joao; Gastaldi, Ada Clarice
Fonte: ELSEVIER SCIENCE INC; NEW YORK Publicador: ELSEVIER SCIENCE INC; NEW YORK
Tipo: Artigo de Revista Científica
ENG
Relevância na Pesquisa
126.46%
Background and objectives: Longitudinal, prospective, randomized, blinded Trial to assess the influence of pleural drain (non-toxic PVC) site of insertion on lung function and postoperative pain of patients undergoing coronary artery bypass grafting in the first three days post-surgery and immediately after chest tube removal. Method: Thirty six patients scheduled for elective myocardial revascularization with cardiopulmonary bypass (CPB) were randomly allocated into two groups: SX group (subxiphoid) and IC group (intercostal drain). Spirometry, arterial blood gases, and pain tests were recorded. Results: Thirty one patients were selected, 16 in SX group and 15 in IC group. Postoperative (PO) spirometric values were higher in SX than in IC group (p < 0.05), showing less influence of pleural drain location on breathing. PaO2 on the second PO increased significantly in SX group compared with IC group (p < 0.0188). The intensity of pain before and after spirometry was lower in SX group than in IC group (p < 0.005). Spirometric values were significantly increased in both groups after chest tube removal. Conclusion: Drain with insertion in the subxiphoid region causes less change in lung function and discomfort, allowing better recovery of respiratory parameters.

Análise do grau de lesão obstrutiva coronária e sua correspondente parede miocárdica como fatores preditivos de perviedade e remodelamento da artéria radial na revascularização do miocárdio; Analysis of coronary obstruction and irrigated myocardial wall as predictive factors for patency and remodeling of radial artery grafts in coronary artery bypass surgery

Carneiro, Luciano Jannuzzi
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 17/02/2009 PT
Relevância na Pesquisa
116.53%
A artéria radial (AR) constitui valiosa opção de enxerto na revascularização do miocárdio (RM), desde a retomada de seu uso, nos anos 1990. O objetivo deste estudo foi avaliar perviedade e remodelamento dos enxertos de AR e sua relação com lesão obstrutiva pré-operatória e parede miocárdica revascularizada, observando-se também os enxertos de artéria torácica interna (ATI). CASUÍSTICA E MÉTODO: Entre 1994 e 2007, 3.964 pacientes foram operados com uso da AR, no InCor/HCFMUSP. Foram selecionados os reestudos angiográficos (12 meses) de 100 pacientes, sendo 11 deles reestudados em duas épocas diferentes. Em 92 pacientes foi utilizada a ATI. Foram determinados os diâmetros médios de AR e ATI, através do software CASS-II®. RESULTADOS: O tempo médio de reestudo foi de 70,53 ±33,18 meses. Em 82 casos (82,0%), a AR revascularizou uma única coronária, mais freqüentemente (50,83%) os ramos marginal esquerdo (ME) ou ventricular posterior (VP/CX). As obstruções pré-operatórias entre 90 e 99% foram as mais prevalentes (39,0%). A perviedade observada foi de 80 casos para AR (80,0%) e 80 para ATIE (86,96%). Houve correlação entre as maiores obstruções pré-operatórias e maior perviedade da AR (p=0,024). Os diâmetros médios dos enxertos foram de 2...

Efeitos da filtragem de leucócitos sobre a resposta inflamatória e a função pulmonar de pacientes submetidos à revascularização miocárdica com circulação extracorpórea; Effects of leukocyte filtering on the inflammatory response and pulmonary function in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass

Amorim, Celio Gomes de
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 09/09/2014 PT
Relevância na Pesquisa
116.4%
INTRODUÇÃO E OBJETIVOS: A Circulação extracorpórea (CEC) é associada a ativação leucocitária, resposta inflamatória e disfunção pulmonar. Objetivou-se avaliar os efeitos da filtragem leucocitária sobre a resposta inflamatória e a função pulmonar em indivíduos submetidos à revascularização do miocárdio (RM) com CEC. MÉTODO: Após aprovação pelo Comitê de Ética Institucional e obtenção do consentimento informado dos indivíduos, foi realizado estudo prospectivo randomizado, para comparar indivíduos adultos submetidos à RM com CEC, utilizando-se filtragem leucocitária (n=09) ou filtro standard (n=11) durante a CEC. Tomografia computadorizada (CT) de tórax, espirometria, análise da oxigenação e hemograma foram realizados antes da cirurgia. A anestesia foi induzida por via venosa com etomidato (0,3 mg.kg-1), sufentanil (0,3 ug.kg-1), pancurônio (0,08 mg.kg-1) e mantida com isoflurano (0,5 - 1,0 CAM) e sufentanil (0,5 ug.kg-1.h-1). A ventilação mecânica utilizou volume corrente de 8 mL.kg-1, com FiO2 de 0,6 e PEEP de 5 cm H2O, exceto durante a CEC. No grupo Filtragem, durante a CEC, foi inserido um filtro de leucócitos na linha arterial do circuito (LG-6, Pall Biomedical Products) e, no grupo Controle...

A randomized, double-blind, and placebo-controlled study with tranexamic acid of bleeding and fibrinolytic activity after primary coronary artery bypass grafting

Santos,A.T.L.; Kalil,R.A.K.; Bauemann,C.; Pereira,J.B.; Nesralla,I.A.
Fonte: Associação Brasileira de Divulgação Científica Publicador: Associação Brasileira de Divulgação Científica
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2006 EN
Relevância na Pesquisa
116.48%
Cardiopulmonary bypass is frequently associated with excessive blood loss. Platelet dysfunction is the main cause of non-surgical bleeding after open-heart surgery. We randomized 65 patients in a double-blind fashion to receive tranexamic acid or placebo in order to determine whether antifibrinolytic therapy reduces chest tube drainage. The tranexamic acid group received an intravenous loading dose of 10 mg/kg, before the skin incision, followed by a continuous infusion of 1 mg kg-1 h-1 for 5 h. The placebo group received a bolus of normal saline solution and continuous infusion of normal saline for 5 h. Postoperative bleeding and fibrinolytic activity were assessed. Hematologic data, convulsive seizures, allogeneic transfusion, occurrence of myocardial infarction, mortality, allergic reactions, postoperative renal insufficiency, and reopening rate were also evaluated. The placebo group had a greater postoperative blood loss (median (25th to 75th percentile) 12 h after surgery (540 (350-750) vs 300 (250-455) mL, P = 0.001). The placebo group also had greater blood loss 24 h after surgery (800 (520-1050) vs 500 (415-725) mL, P = 0.008). There was a significant increase in plasma D-dimer levels after coronary artery bypass grafting only in patients of the placebo group...

Surgical results of coronary artery bypass grafting without cardiopulmonary bypass: analysis of 3,410 patients

Lima,Ricardo de Carvalho; Escobar,Mozart Augusto Soares; Lobo Filho,José Glauco; Diniz,Roberto; Saraiva,Antonio; Césio,Antonio; Gesteira,Mário; Vasconcelos,Frederico
Fonte: Sociedade Brasileira de Cirurgia Cardiovascular Publicador: Sociedade Brasileira de Cirurgia Cardiovascular
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/09/2003 EN
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126.54%
OBJECTIVES: Over the past few years, great strides have been made in off-pump coronary surgery. This progress is due to a combination of the advances in surgical techniques and the development of instruments that make it possible to perform this procedure in the most varied situations. This is a retrospective study, the purpose of which is to assess our experience with this procedure over the last eleven and a half years. The authors underscore the rapid progress of the method in recent years and report on its indications, contraindications and results. METHODS: In the period from August 1991 to December 2003, 3,410 consecutively patients suffering from angina pectoris were submitted to off-pump coronary surgery. Ages ranged from 13 to 93 years, with a mean of 63 ± 12.0 years. Males accounted for 58% of the cases. The angina was rated according to the criteria of the Canadian Cardiovascular Society, 6.1% of the patients being in Class I, 6.8% in Class II, 46.3% in Class III and 40.8% in Class IV. RESULTS: Intraoperative mortality was low (0.4%). Hospital mortality (30 postoperative days) was 2.5%. Mortality and morbidity among the octogenarian patients were extremely low compared with patients operated on with cardiopulmonary bypass (CPB) (2.2% versus 12.6%) (p<0.001). Postoperative complications regarded as nonfatal occurred in 7.6%. In the final year no difference was observed between the number of conduits in the patients operated on with and without CPB [with CPB 2.8 ± 1.2 and without 2.8 ± 0.8 (NS)]. Acute myocardial infarction was the most frequent complication...

Comparative study of traditional long incision vein harvesting and multiple incisions with small skin bridges in patients with coronary artery bypass grafting at King Abdullah University Hospital - Jordan

Hijazi,Emad Mohamed
Fonte: Sociedade Brasileira de Cirurgia Cardiovascular Publicador: Sociedade Brasileira de Cirurgia Cardiovascular
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/06/2010 EN
Relevância na Pesquisa
116.41%
OBJECTIVE: Saphenous vein harvesting can be associated with wound complications, incision pain, infection, and poor cosmetic outcome. The objective of our study is to determine the difference in wound complication and infection rates between two saphenous vein harvesting techniques, long incision versus multiple short interrupted incisions (tunneling) for coronary artery bypass grafting at the King Abdullah University Hospital - Jordan. METHODS: Retrospectively we analyzed data from 1,050 consecutive elective coronary artery bypass procedures performed from May 5, 2003, to December 31, 2007, in our institution. Saphenectomy using traditional Long incision vein harvesting (Group 1) performed in six hundred and fifty patients (n=650), while saphenectomy using multiple incisions with small skin bridges - tunneling (Group 2) performed in four hundred patients (n=400). Saphenectomy performed by the cardiac surgery assistant or main cardiac surgeon. Inflammation, dehiscence, cellulites, lymphangitis, drainage, necrosis, or abscess necessitating dressing, antibiotics or debridement before complete healing without eschar were defined as wound complications. There was no statistical difference in preoperative risk factors in both groups. Test results were considered significant when P<0.05. RESULTS: Leg wound complications observed more in traditional long incision vein harvesting technique (P=0.0005). Female gender...

Predictors of transfusion of packed red blood cells in coronary artery bypass grafting surgery

Sá,Michel Pompeu Barros de Oliveira; Soares,Evelyn Figueira; Santos,Cecília Andrade; Figueiredo,Omar Jacobina; Lima,Renato Oliveira Albuquerque; Rueda,Fábio Gonçalves de; Escobar,Rodrigo Renda de; Soares,Alexandre Magno Macário Nunes; Lima,Ricardo de
Fonte: Sociedade Brasileira de Cirurgia Cardiovascular Publicador: Sociedade Brasileira de Cirurgia Cardiovascular
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/12/2011 EN
Relevância na Pesquisa
116.41%
OBJECTIVES: Finding predictors of blood transfusion may facilitate the most efficient approach for the use of blood bank services in coronary artery bypass grafting procedures. The aim of this retrospective study is to identify preoperative and intraoperative patient characteristics predicting the need for blood transfusion during or after CABG in our local cardiac surgical service. METHODS: 435 patients undergoing isolated first-time CABG were reviewed for their preoperative and intraoperative variables and analyzed postoperative data. Patients were 255 males and 180 females, with mean age 62.01 ± 10.13 years. Regression logistic analysis was used for identifying the strongest perioperative predictors of blood transfusion. RESULTS: Blood transfusion was used in 263 patients (60.5%). The mean number of transfused blood products units per patient was 2.27 ± 3.07 (0-23) units. The total number of transfused units of blood products was 983. Univariate analysis identified age >65 years, weight <70 Kg, body mass index <25 Kg/m2, hemoglobin <13mg/dL, hematocrit < 40% and ejection fraction <50%, use of cardiopulmonary bypass (CPB), not using an internal thoracic artery as a bypass, and multiple bypasses as significant predictors. The strongest predictors using multivariate analysis were hematocrit < 40% (OR 2.58; CI 1.62-4.15; P<0.001)...

Pleural subxyphoid drain confers better pulmonary function and clinical outcomes in chronic obstructive pulmonary disease after off-pump coronary artery bypass grafting: a randomized controlled trial

Guizilini,Solange; Viceconte,Marcela; Esperança,Gabriel Tavares da M.; Bolzan,Douglas W.; Vidotto,Milena; Moreira,Rita Simone L; Câncio,Andréia Azevedo; Gomes,Walter J
Fonte: Sociedade Brasileira de Cirurgia Cardiovascular Publicador: Sociedade Brasileira de Cirurgia Cardiovascular
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/12/2014 EN
Relevância na Pesquisa
116.48%
Objective: To evaluate the lung function and clinical outcome in severe chronic obstructive pulmonary disease in patients undergoing off-pump coronary artery bypass grafting with left internal thoracic artery graft, comparing the pleural drain insertion in the intercostal versus subxyphoid region. Methods: A randomized controlled trial. Chronic obstructive pulmonary disease patients were randomized into two groups according pleural drain site: II group (n=27) - pleural drain in intercostal space; SI group (n=29) - pleural drain in the subxyphoid region. Spirometry values (Forced Vital Capacity - and Forced expiratory volume in 1 second) were obtained on preoperative and 1, 3 and 5 postoperative days. Chest x-ray from preoperative until postoperative day 5 (POD5) was performed for monitoring respiratory events, such as atelectasis and pleural effusion. Pulmonary shunt fraction and pain score was evaluate preoperatively and on postoperative day 1. Results: In both groups there was a significant decrease of the spirometry values (Forced Vital Capacity and Forced expiratory volume in 1 second) until POD5 (P<0.05). However, when compared, SI group presented less decrease in these parameters (P<0.05). Pulmonary shunt fraction was significantly lower in SI group (P<0.05). Respiratory events...

Implantation of transcatheter aortic valve prosthesis through the ascending aorta concomitant with coronary artery bypass grafting without cardiopulmonary bypass

Leal,João Carlos Ferreira; Avanci,Luis Ernesto; Abelaira Filho,Achilles; Almeida,Thiago Faria; Braile,Domingo Marcolino
Fonte: Sociedade Brasileira de Cirurgia Cardiovascular Publicador: Sociedade Brasileira de Cirurgia Cardiovascular
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/12/2014 EN
Relevância na Pesquisa
116.46%
Introdution: The transcatheter aortic valve implantation in the treatment of high-risk symptomatic aortic stenosis has increased the number of implants every year. The learning curve for transcatheter aortic valve implantation has improved since the last 12 years, allowing access alternatives. Objective: The aim of this study is to approach the implantation of transcatheter aortic valve through transaortic via associated with off-pump cardiopulmonary bypass surgery in a 67-year-old man, with chronic obstructive pulmonary disease, arterial hypertension and kidney transplant. Methods: Off-pump coronary artery bypass surgery was performed and the valve in the aortic position was released successfully. Results: There were no complications in the intraoperative and postoperative period. Gradient reduction, effective orifice increasing of the prosthesis and absence of valvular regurgitation after implantation were observed by transesophageal echocardiography. Conclusion: Procedural success demonstrates that implantation of transcatheter aortic valve through the ascending aorta associated with coronary artery bypass surgery without CPB is a new option for these patients.

Does the use of paclitaxel or rapamycin-eluting stent decrease further need for coronary-artery bypass grafting when compared with bare-metal stent?

Lemos Júnior,Hernani Pinto de; Atallah,Álvaro Nagib
Fonte: Associação Paulista de Medicina - APM Publicador: Associação Paulista de Medicina - APM
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/07/2007 EN
Relevância na Pesquisa
116.56%
CONTEXT AND OBJECTIVE: The safety and efficacy of drug-eluting stents reduce the need for surgical revascularization. The objective of the present study was to investigate whether paclitaxel or rapamycin-eluting stent are effective in avoiding the need for coronary-artery bypass grafting. METHODS: This was a systematic review of the literature using the methodology of the Cochrane Collaboration. The type of study considered was controlled randomized trials; the type of intervention was drug-eluting or bare-metal stents; and the main outcome investigated was coronary-artery bypass grafting. RESULTS: The ten studies included in this systematic review did not show any statistically significant difference between the drug-eluting stents and the bare-metal stents with regard to the outcome of coronary-artery bypass grafting (confidence interval: 0.31 to 1.42). CONCLUSION: The surgical revascularization rate was not reduced by the use of drug-eluting stents.

Induction of anesthesia in coronary artery bypass graft surgery: the hemodynamic and analgesic effects of ketamine

Basagan-Mogo,Elif; Goren,Suna; Korfali,Gulsen; Turker,Gurkan; Kaya,Fatma Nur
Fonte: Faculdade de Medicina / USP Publicador: Faculdade de Medicina / USP
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2010 EN
Relevância na Pesquisa
116.62%
OBJECTIVE: The aim of this prospective, randomized study was to evaluate the hemodynamic and analgesic effects of ketamine by comparing it with propofol starting at the induction of anesthesia until the end of sternotomy in patients undergoing coronary artery bypass grafting surgery. INTRODUCTION: Anesthetic induction and maintenance may induce myocardial ischemia in patients with coronary artery disease. A primary goal in the anesthesia of patients undergoing coronary artery bypass grafting surgery is both the attenuation of sympathetic responses to noxious stimuli and the prevention of hypotension. METHODS: Thirty patients undergoing coronary artery bypass grafting surgery were randomized to receive either ketamine 2 mg.kg-1 (Group K) or propofol 0.5 mg.kg-1 (Group P) during induction of anesthesia. Patients also received standardized doses of midazolam, fentanyl, and rocuronium in the induction sequence. The duration of anesthesia from induction to skin incision and sternotomy, as well as the supplemental doses of fentanyl and sevoflurane, were recorded. Heart rate, mean arterial pressure, central venous pressure, pulmonary arterial pressure, pulmonary capillary wedge pressure, cardiac index, systemic and pulmonary vascular resistance indices...

Risk-Adjusted Survival after Coronary Artery Bypass Grafting: Implications for Quality Improvement

Efird, Jimmy T.; O’Neal, Wesley T.; Davies, Stephen W.; O’Neal, Jason B.; Kindell, Linda C.; Anderson, Curtis A.; Chitwood, W. Randolph; Ferguson, T. Bruce; Kypson, Alan P.
Fonte: MDPI Publicador: MDPI
Tipo: Artigo de Revista Científica
EN_US
Relevância na Pesquisa
126.5%
Mortality represents an important outcome measure following coronary artery bypass grafting. Shorter survival times may reflect poor surgical quality and an increased number of costly postoperative complications. Quality control efforts aimed at increasing survival times may be misleading if not properly adjusted for case-mix severity. This paper demonstrates how to construct and cross-validate efficiency-outcome plots for a specified time (e.g., 6-month and 1-year survival) after coronary artery bypass grafting, accounting for baseline cardiovascular risk factors. The application of this approach to regional centers allows for the localization of risk stratification rather than applying overly broad and non-specific models to their patient populations.

Comparação de dois modos de ventilação não invasiva (ventilação assistida proporcional e ventilação com pressão de suporte) no pós-operatório de revascularização do miocárdio; Comparison of two noninvasive ventilation modes (proportional assist ventilation and pressure support ventilation) in the postoperative of coronary artery bypass grafting surgery

Silva, Fábia Diniz
Fonte: Universidade Federal de Uberlândia Publicador: Universidade Federal de Uberlândia
Tipo: Dissertação
POR
Relevância na Pesquisa
126.39%
As complicações pulmonares no pós-operatório de cirurgia cardíaca são as principais causas de prolongamento do tempo de internação, morbidade e mortalidade. A ventilação não invasiva (VNI) é empregada no pós-operatório no intuito de evitar ou reverter o dano pulmonar. O presente estudo teve como objetivo comparar dois modos de ventilação não invasiva utilizando ou ventilação com pressão de suporte (VPS) ou ventilação assistida proporcional (PAV) nos pacientes em pós-operatório de revascularização cirúrgica do miocárdio, avaliando-se a segurança, a percepção de dispneia, as trocas gasosas e qual dos modos é mais confortável para o paciente. Vinte e cinco pacientes foram randomizados em dois grupos; treze deles realizaram ventilação não invasiva no modo PAV e doze, na VPS. Foram obtidas gasometria arterial com o paciente respirando ar ambiente e radiografia de tórax antes de se iniciar o estudo e após a última sessão de VNI. Foram realizadas duas sessões diárias de VNI, com duração de 30 minutos cada, durante dois dias consecutivos. A frequência cardíaca e a pressão arterial foram aferidas antes do início da VNI, nos instantes 10 e 20 minutos e após cada sessão. A oximetria de pulso e a frequência respiratória foram medidas antes...

Perioperativer Verlauf von BNP (brain natriuretic peptide) nach aortokoronarer Bypassoperation bei Patienten mit präoperativ reduzierter LV-Funktion; Perioperative changes of BNP (brain natriuretic peptide) after coronary artery bypass grafting in patients with preoperative reduced left ventricular function

Kofler, Melanie
Fonte: Universidade de Tubinga Publicador: Universidade de Tubinga
Tipo: Dissertação
DE_DE
Relevância na Pesquisa
126.47%
Einleitung: Das vom Herzen gebildete BNP (brain natriuretic peptide) ist durch seiner natriuretische, diuretische und vasodilatative Wirkung maßgeblich an der kardio-pulmonalen und hämodynamischen Homöostase beteiligt. Die BNP-Plasma-konzentrationen stellen außerdem einen Marker zur Beurteilung einer linksventrikuläre Dysfunktion dar. In der Vergangenheit gab es nur wenige Studien, die sich mit dem perioperativen Verlauf von BNP nach aortokoronarer Bypassoperation beschäftigt haben. Methoden: Wir haben in unserer Studie 11 Patienten (9 Männer, 2 Frauen; mittleres Alter 63,7 +/- 8,5 Jahre) mit präoperativ schwer eingeschränkter LV-Funktion (mittlere LVEF: 33,8 +/- 6,0 %, zwischen 25 und 45 %) ausgewählt, um den Verlauf der BNP-Werte nach erfolgreicher Bypassoperation und deren Zusammenhang mit hämo-dynamischen Parametern (HZV, CI, SV, SVR, PCWP und PAP) zu untersuchen. Darüber hinaus wurden perioperativ verabreichte inotrope Substanzen, die Dauer der Aortenabklemmung (AKZ) sowie die OP-Dauer dokumentiert. Ergebnisse: Die präoperativen BNP-Werte waren mit 98,06 +/- 59,43 pg/ml auf ca. ein 20-faches der Norm erhöht. Wir fanden einen signifikant negativen Zusammenhang mit der präoperativen LVEF (r = - 0,78, p = 0,013). Postoperativ kam es zu einem kontinuierlichen Anstieg der BNP-Werte mit einem Maximum nach 24 Stunden auf ca. ein 40-faches der Norm. Zum Zeitpunkt des BNP-Maximums fanden wir signifikant negative Korrelationen der BNP-Werte mit dem HZV...

Relationship between pre-extubation positive endexpiratory pressure and oxygenation after coronary artery bypass grafting

Lima,Reijane Oliveira; Borges,Daniel Lago; Costa,Marina de Albuquerque Gonçalves; Baldez,Thiago Eduardo Pereira; Silva,Mayara Gabrielle Barbosa e; Sousa,Felipe André Silva; Soares,Milena de Oliveira; Pinto,Jivago Gentil Moreira
Fonte: Sociedade Brasileira de Cirurgia Cardiovascular Publicador: Sociedade Brasileira de Cirurgia Cardiovascular
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/08/2015 EN
Relevância na Pesquisa
116.55%
AbstractIntroductionAfter removal of endotracheal tube and artificial ventilation, ventilatory support should be continued, offering oxygen supply to ensure an arterial oxygen saturation close to physiological.Objective:The aim of this study was to investigate the effects of positive-end expiratory pressure before extubation on the oxygenation indices of patients undergoing coronary artery bypass grafting.Methods:A randomized clinical trial with seventy-eight patients undergoing coronary artery bypass grafting divided into three groups and ventilated with different positive-end expiratory pressure levels prior to extubation: Group A, 5 cmH2O (n=32); Group B, 8 cmH2O (n=26); and Group C, 10 cmH2O (n=20). Oxygenation index data were obtained from arterial blood gas samples collected at 1, 3, and 6 h after extubation. Patients with chronic pulmonary disease and those who underwent off-pump, emergency, or combined surgeries were excluded. For statistical analysis, we used Shapiro-Wilk, G, Kruskal-Wallis, and analysis of variance tests and set the level of significance at P<0.05.ResultsGroups were homogenous with regard to demographic, clinical, and surgical variables. There were no statistically significant differences between groups in the first 6 h after extubation with regard to oxygenation indices and oxygen therapy utilization.Conclusion:In this sample of patients undergoing coronary artery bypass grafting...

Intercorrências clínicas no membro submetido à exérese de veia safena magna para revascularização do miocárdio; Clinical complications of limb undergone harvesting of great saphenous vein for coronary artery bypass grafting using bridge technique

BELCZAK, Cleusa Ema Quilici; TYSZKA, André Luiz; GODOY, Jose Maria Pereira de; RAMOS, Rubiana Neves; BELCZAK, Sergio Quilici; CAFFARO, Roberto Augusto
Fonte: Sociedade Brasileira de Cirurgia Cardiovascular Publicador: Sociedade Brasileira de Cirurgia Cardiovascular
Tipo: Artigo de Revista Científica
POR
Relevância na Pesquisa
116.41%
OBJETIVO: Avaliar as intercorrências clínicas nos membros submetidos a retirada da veia safena magna por técnica de incisões escalonadas para sua utilização como enxerto venoso na revascularização do miocárdio. MÉTODOS: Selecionou-se aleatoriamente 44 pacientes submetidos a revascularização do miocárdio utilizando a veia safena magna retirada por incisões escalonadas há mais de 3 meses. Critérios de exclusão: retirada da veia safena de ambos os lados; safenectomia prévia do membro contralateral; etiologias de edema de causas sistêmicas, tais como cardíacas, renais, tireoideanas, hepáticas e insuficiência venosa nos membros inferiores (MMII), representada por varizes exuberantes com ou sem alterações tróficas. Foram avaliados as seguintes variáveis: idade, sexo, diabetes, tempo de cirurgia, presença de intercorrências, como edema, parestesias, infecção, linforréia, erisipela e trombose venosa profunda. A avaliação foi clínica e o diagnóstico do diabete foi feito pelos exames do pré-operatório para cirurgia. Para análise estatística foram empregados o teste qui-quadrado, teste exato de Fisher e teste t de Student, considerando erro alfa de 5%. RESULTADOS: O tempo entre avaliação e cirurgia foi de 3 a 187 meses...

Early outcome after off-pump coronary artery bypass grafting: effect on mortality and stroke

Reber,Delawer; Fritz,Marcus; Germing,Alfred; Marks,Peter; Laczkovics,Axel
Fonte: Sociedade Brasileira de Cirurgia Cardiovascular Publicador: Sociedade Brasileira de Cirurgia Cardiovascular
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/03/2008 EN
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116.52%
OBJECTIVE: One of the major and devastating complications of the coronary artery bypass grafting (CABG) is the stroke. Avoiding cardiopulmonary bypass (CPB) may reduce this neurological complication. In the past years there was an increased interest in the off-pump coronary artery grafting (OPCAB). The benefit of this method of revascularization in term of stroke and mortality is controversially discussed. METHODS: A retrospective analysis of collected data from 252 patients were operated without cardiopulmonary bypass out of 1516 CABG procedures from January 2004 through May 2006. The mean age of the patient population was 70±11years, within a range of 27-88 years. Forty-eight (19%) patients were older than 80 years and there were 172 (69%) males. Mean graft per patient was 1.78±0.79. The internal mammary artery (IMA) graft was used in 95% of the patients. For eight (3.17%) patients this was the second procedure. RESULTS: Hospital mortality was 3.17%; Mean EuroSCORE in these patients was 10.36±6.67. No neurological complications occurred, six (2.38%) patients had temporary psycho syndrome. Postoperative myocardial infarction occurred in three (1.19%) patients. Two patients required rethoracotomy as a result of bleeding. Thirty-eight (15%) patients needed postoperative therapy for atrial fibrillation. CONCLUSION: CABG with OPCAB technique has the benefit of low mortality and morbidity in terms of stroke. The advantages of this technique depends on the patient's general condition at the time of the operation...

Induction of anesthesia in coronary artery bypass graft surgery: the hemodynamic and analgesic effects of ketamine

Basagan-Mogo, Elif; Goren, Suna; Korfali, Gulsen; Turker, Gurkan; Kaya, Fatma Nur
Fonte: Universidade de São Paulo. Faculdade de Medicina Publicador: Universidade de São Paulo. Faculdade de Medicina
Tipo: info:eu-repo/semantics/article; info:eu-repo/semantics/publishedVersion; ; ; ; ; ; Formato: application/pdf
Publicado em 01/01/2010 ENG
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116.57%
OBJECTIVE: The aim of this prospective, randomized study was to evaluate the hemodynamic and analgesic effects of ketamine by comparing it with propofol starting at the induction of anesthesia until the end of sternotomy in patients undergoing coronary artery bypass grafting surgery. INTRODUCTION: Anesthetic induction and maintenance may induce myocardial ischemia in patients with coronary artery disease. A primary goal in the anesthesia of patients undergoing coronary artery bypass grafting surgery is both the attenuation of sympathetic responses to noxious stimuli and the prevention of hypotension. METHODS: Thirty patients undergoing coronary artery bypass grafting surgery were randomized to receive either ketamine 2 mg.kg-1 (Group K) or propofol 0.5 mg.kg-1 (Group P) during induction of anesthesia. Patients also received standardized doses of midazolam, fentanyl, and rocuronium in the induction sequence. The duration of anesthesia from induction to skin incision and sternotomy, as well as the supplemental doses of fentanyl and sevoflurane, were recorded. Heart rate, mean arterial pressure, central venous pressure, pulmonary arterial pressure, pulmonary capillary wedge pressure, cardiac index, systemic and pulmonary vascular resistance indices...

Effect of vitamin A supplementation on clinical evolution in patients undergoing coronary artery bypass grafting, according to serum levels of zinc

Matos,A. C.; Souza,G. G.; Moreira,V.; Ramalho,A.
Fonte: Nutrición Hospitalaria Publicador: Nutrición Hospitalaria
Tipo: info:eu-repo/semantics/article; journal article; info:eu-repo/semantics/publishedVersion Formato: text/html; application/pdf
Publicado em 01/12/2012 ENG
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126.39%
Vitamin A and zinc are powerful antioxidants with synergy between them, thus protecting the organism against oxidative stress during the pre and postoperative periods. Our aim was to investigate the evolution clinical in patients undergoing coronary artery bypass grafting while receiving vitamin A supplements according to their zinc nutritional status. They were randomly divided into two groups (2:1): Control group (G1 = 60); and Supplemented group (G2 = 30) and subdivided according to the nutritional status of zinc. Serum concentrations of retinol, β-carotene, zinc and levels of malondialdehyde were measured prior to (T0) and on the 21st day (T1) following surgery. After surgery, was found a significant difference between G1 and G2 when comparing retinol (G1 = 38.7 ± 17.1 μg/dL and G2 = 62.1 ± 20.3 μg/dL; p < 0.001) and β-carotene (G1 = 12.3 ± 5.7 μg/dL and G2 = 53.5 ± 20.9 μg/dL; p < 0.001) in the patients with adequate concentrations of zinc. Analyzing the evolution clinical, operative mortality was 8.33% in G1 and 3.33% in G2. Hospitalization time significantly smaller in the G2 was found in the patients who had adequate concentrations of zinc (p = 0.001), as well as time in the intensive care unit both in those with adequate and inadequate levels of zinc (p = 0.047; p = 0.039). Such results may indicate that vitamin A supplementation may have a positive impact in combating the oxidative stress to which these patients are exposed above all in patients with adequate levels of zinc.