PREDICTORS OF NEUROLOGICAL COMPLICATIONS AFTER CARDIAC SURGICAL INTERVENTIONS IN OLDERY PATIENTS

2020 ◽  
pp. 319-324
Author(s):  
О. В. Каменская ◽  
А. С. Клинкова ◽  
В. В. Ломиворотов ◽  
В. А. Шмырев ◽  
А. М. Чернявский
Keyword(s):  
Intraoperative Monitoring ◽  
Cerebral Oxygenation ◽  
Artery Bypass ◽  
Neurological Complications ◽  
Myocardial Infarctions ◽  
Bypass Grafting ◽  
Surgical Interventions ◽  
Increased Risk ◽  
History Of ◽  
Left And Right

Для выявления предикторов неврологических осложнений в госпитальный период после коронарного шунтирования (КШ) проанализированы данные 92 больных 70 лет и старше с ИБС. Интраоперационно проведен мониторинг церебральной оксигенации ( rSO , %). На этапе вводной анестезии средний уровень rSO по правому и левому полушариям составлял 64-65% без значительных изменений во время операции. Снижение rSO во время искусственного кровообращения (ИК) связано с увеличением риска развития неврологических осложнений в раннем послеоперационном периоде. При снижении rSO во время ИК на 20% и более относительно исходных значений по левому и правому полушариям риск неблагоприятных неврологических событий возрастает в 7 и 9 раз соответственно. Два и более инфаркта миокарда в анамнезе в 3 раза увеличивают риск неврологических осложнений после КШ. To identify predictors of neurological complications in the hospital period after coronary artery bypass grafting (CABG), 92 patients with coronary heart disease aged 70 years and over were analyzed. Intraoperative monitoring of cerebral oxygenation ( rSO , %) was carried out. At the stage of induction anesthesia, the average level of rSO for left and right hemispheres was 64-65 % without significant changes during the operation. A decrease in rSO during cardiopulmonary bypass (CPB) was associated with increased risk of neurological complications. The risk of neurological complications increase 7-fold and 9-fold with a decrease in rSO by 20 % or more during CPB relative to baseline for left and right hemispheres, respectively. A history of two or more myocardial infarctions increases 3-fold the risk of neurological complications after CABG.

Coronary Artery Bypass Grafting in a Patient with Organophosphate Poisoning

2015 ◽  
Vol 18 (4) ◽  
pp. 167 ◽  
Author(s):  
Rajeeva R. Pieris ◽  
Ravindra Fernando
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Previous History ◽  
Organophosphate Poisoning ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Excellent Health ◽  
History Of

A 43-year-old male, with no previous history of mental illness, was diagnosed with coronary heart disease, after which he became acutely depressed and attempted suicide by ingesting an organophosphate pesticide. He was admitted to an intensive care unit and treated with pralidoxime, atropine, and oxygen. His coronary occlusion pattern required early coronary artery bypass grafting (CABG) surgery. His family, apprehensive of a repeat suicidal attempt, requested surgery be performed as soon as possible. He recovered well from the OP poisoning and was mentally fit to express informed consent 2 weeks after admission. Seventeen days after poisoning, he underwent coronary artery bypass grafting and recovered uneventfully. Six years later, he remains in excellent health. We report this case because to the best of our knowledge there is no literature regarding CABG performed soon after organophosphate poisoning.

Psychological status of patients after coronary artery bypass grafting: Data from a 5-year-follow-up study

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
O Raykh ◽  
A Sumin ◽  
E Korok
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Artery Bypass ◽  
Type D Personality ◽  
Psychological Status ◽  
Myocardial Infarctions ◽  
Bypass Grafting ◽  
Type D ◽  
Repeat Procedures

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Federal State Budgetary Scientific Institution “Research Institute for Complex Issues of Cardiovascular Diseases” Negative psychological status is acknowledged as one of risk of development of cardiovascular pathology.  However, predictive value of type D personality (psychosocial distress) in different cultures and the countries are not fully understood. Purpose: Study aim was to investigate the association of type D personality and quality of life (QoL) with the development of cardiovascular complication in patients in five years after coronary artery bypass grafting (CABG). Materials and Methods: Evaluation of psychological status and combined risk of nonfatal (strokes, nonfatal myocardial infarctions, repeat procedures of revascularization and hospitalization due to relapse or progression of angina pectoris) and fatal (general and cardiovascular mortality) cases before and in five years after CABG. Patients with chronic ischemic heart disease (n = 602, 112 (18.5%) females and 490 (81.5%) males, mean age = 57.7 ± 7.3 years.) who had had CABG were included in the study. Who were formed in two groups: patients with the presence of type D (n= 134) and patients without type D (n = 468). The study of the psychological status was carried out using questionnaire DS-14.  Analysis of long-term results were assessed using the Kaplan–Meier method. Data was collected by a SF-36 questionnaire, comprising of 36 questions divided in 8 domains. The score was designated as 0 to 100; with the higher score being indicative of a better QoL.  Results: Frequency of fatal cases in both groups amounted 8.3% and 8.1% (p = 0.145), in turn nonfatal end-points in group with type D amounted 31.8%, and 15.9% in group without type D (p = 0.044) in during the 5 years. Presence of type D personality at initial examination increased 3.21 times combined risk of nonfatal and fatal cases (OR 3.21, 95%  CI 2.02-6.14, p = 0.002). In long term period there were no differences in survival between groups type D and without type D (95.5% vs. 96.8%), There were  differences in groups type D and without type D in nonfatal events (strokes, nonfatal myocardial infarctions, secondary endpoint: repeat procedures of revascularization and hospitalization due to relapse or progression of angina pectoris) (respectively, 97.1% vs 88.0%, (p = 0.341). Findings showed that 75% of subjects  reported well QoL, while the mean score regarding QoL in patients with type D personality, were higher than in patients without type D in all health related dimensions. Based on t-test difference, the of QoL in  in patients with type D and  in patients without type D for physical health (p < 0.015), mental limitation (p < 0.043), somatic pain (p < 0.022) and mental health (p < 0.041) was observed. Conclusion: Type D patients had a greater risk for nonfatal cardiac events and lower  QoL indicators, compared with non Type D patients.  Accumulated proofs indicate that in detection of patients at risk of development of stress induced cardiac complications after CABG  it is reasonable to use approach which involves consideration of personality type.

Impact of a History of Hypertension on Symptoms and Quality of Life Prior to and at Five Years after Coronary Artery Bypass Grafting

2000 ◽  
Vol 9 (1) ◽  
pp. 52-63 ◽  
Author(s):  
Johan Herlitz ◽  
Kenneth Caidahl ◽  
Ingela Wiklund ◽  
Helén Sjöland ◽  
Björn Karlson ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
History Of

Early Neurological Complications after Cardiac/Aortic Surgery with Cardiopulmonary Bypass: Incidence and Risk Factors

2021 ◽  
Vol 104 (7) ◽  
pp. 1060-1066
Keyword(s):  
Cardiopulmonary Bypass ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Artery Bypass ◽  
Aortic Surgery ◽  
Neurological Complications ◽  
Serum Lactate ◽  
Valve Surgery ◽  
History Of ◽  
Bypass Technique

Objective: To examine the incidence and risk factors of early neurological complications after cardiac or aortic surgery using cardiopulmonary bypass technique in King Chulalongkorn Memorial Hospital, Thailand. Materials and Methods: The present study was a retrospective cohort study. Clinical data of adult patients that underwent cardiac or aortic surgery using cardiopulmonary bypass technique in 2018 were reviewed from the electronic medical record in the authors’ center. Results: Early postoperative neurological complications occurred in 33 (8.3%) of the 400 patients. Twenty of them (60.6%) had non-specific encephalopathy, three (9.1%) had hypoxic-ischemic encephalopathy, five (15.2%) had provoked seizure, four (12.1%) had cerebral infarction, and one (3.0%) had intracranial hemorrhage. Associated clinical factors included history of essential hypertension [adjusted odds ratio 3.448 (95% CI 1.266 to 9.391)], combined coronary artery bypass grafting and valve surgery [adjusted odds ratio 4.759 (95% CI 1.182 to 19.170)], multi-valve surgery [adjusted odds ratio 5.201 (95% CI 1.227 to 22.049)], aortic surgery [adjusted odds ratio 17.260 (95% CI 4.168 to 71.468)], higher midazolam dosage [adjusted odds ratio 1.009 (95% CI 1.002 to 1.015)], higher serum lactate prior to discontinuing cardiopulmonary bypass [adjusted odds ratio 1.263 (95% CI 1.093 to 1.460)], and presence of intraoperative intra-aortic balloon pump use [adjusted odds ratio 6.160 (95% CI 1.883 to 20.150)]. Conclusion: Early postoperative neurological complications rate of cardiac or aortic surgery using cardiopulmonary bypass technique in the present study settings was 8.3%. Preoperative and intraoperative clinical factors associated with such complications were the history of essential hypertension, the type of surgery such as combined coronary artery bypass grafting and valve surgery, multi-valve surgery, and aortic surgery, the higher midazolam dosage, the higher serum lactate prior to discontinuing cardiopulmonary bypass, and the presence of intraoperative intra-aortic balloon pump use. Keywords: Cardiac surgery; Aortic surgery; Cardiopulmonary bypass; Postoperative neurological complications; Encephalopath

Changing Incidence, Type, and Natural History of Conduction Defects After Coronary Artery Bypass Grafting

2005 ◽  
Vol 80 (5) ◽  
pp. 1732-1737 ◽  
Author(s):  
David J. Cook ◽  
Joseph M. Bailon ◽  
Tonia T. Douglas ◽  
Kathleen D. Henke ◽  
John R. Westberg ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Natural History ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
History Of

P1518Impact of psychological risk factors on cardiovascular prognosis in patients after coronary artery bypass grafting: data from a 5-year-follow-up study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
O I Raykh ◽  
A N Sumin ◽  
E V Korok
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Artery Bypass ◽  
Type D Personality ◽  
Psychological Status ◽  
Myocardial Infarctions ◽  
Bypass Grafting ◽  
Type D ◽  
Repeat Procedures

Abstract Psychosocial stress is acknowledged as one of risk of development of cardiovascular pathology. The interrelation between existence personality type D and prevalence of atherosclerosis is recently established. However, predictive value of type D personality in different cultures and the countries are not fully understood. Purpose Study aim was to investigate the association of type D personality with the development of cardiovascular complication in patients in five years after coronary artery bypass grafting (CABG). Materials and methods Evaluation of psychological status and combined risk of nonfatal (strokes, nonfatal myocardial infarctions, repeat procedures of revascularization and hospitalization due to relapse or progression of angina pectoris) and fatal (general and cardiovascular mortality) cases before and in five years after CABG. Patients with chronic ischemic heart disease (n=602, 112 (18.5%) females and 490 (81.5%) males, mean age=57.7±7.3 years.) who had had CABG were included in the study. Who were formed in two groups: patients with the presence of type D (n=134) and patients without type D (n=468). The study of the psychological status was carried out using questionnaire DS-14. Analysis of long-term results were assessed using the Kaplan–Meier method. Results During the 5 years frequency of fatal cases in both groups amounted 8.3% and 8.1% (p=0.145), in turn nonfatal end-points in group with type D amounted 31.8%, and 15.9% in group without type D (p=0.044). Presence of type D personality at initial examination increased 3.21 times combined risk of nonfatal and fatal cases (OR 3.21, 95% CI 2.02–6.14, p=0.002). In long term period there were no differences in survival between groups type D and without type D (95.5% vs. 96.8%), There were differences in groups type D and without type D in nonfatal events (strokes, nonfatal myocardial infarctions, secondary endpoint: repeat procedures of revascularization and hospitalization due to relapse or progression of angina pectoris) (respectively, 97.1% vs 88.0%, (p=0.34). Conclusion Type D patients had a greater risk for nonfatal cardiac events compared with non Type D patients. Accumulated proofs indicate that in detection of patients at risk of development of stress induced cardiac complications after CABG it is reasonable to use approach which involves consideration of personality type.

Pseudomonas Exit-Site Infections in CAPD Patients: Evolution and Outcome of Treatment

1998 ◽  
Vol 18 (6) ◽  
pp. 637-639 ◽  
Author(s):  
Chi Yuen Lo ◽  
Wai Ling Chu ◽  
Kit Mui Wan ◽  
Suk Yi Ng ◽  
Wai Ling Lee ◽  
...  
Keyword(s):  
Group Iv ◽  
Catheter Removal ◽  
Exit Site ◽  
Dialysis Unit ◽  
Surgical Interventions ◽  
Group Iii ◽  
Tenckhoff Catheter ◽  
Increased Risk ◽  
History Of ◽  
Record Review

Objective To examine the natural history of Pseudomonas aeruginosa (PSA) exit-site infections (ESI) in patients treated with antibiotics with or without surgical interventions. Design Retrospective record review from May 1994 to April 1997. Setting A single dialysis unit in a district hospital. Patients The review included 353 patients who had undergone continuous ambulatory peritoneal dialysis (CAPD). Outcome Measures The prevalence and etiology of ESI, the treatment regimen for PSA ESI, and the outcome of treatment. Results The prevalence of ESI was 55%. A total of 131 episodes (range 1 -5) of PSA ESI occurred in 78 (40.2%) of the 194 patients who experienced ESI. Among these 78 patients, 4 groups with different outcomes were identified.ln group 1,35 patients (44.9%) were treated successfully with antibiotic therapy alone. Among these 35 patients, 4 developed PSA peritonitis at a mean of 5 months (range 2 -10 mth) after apparent clinical resolution of PSA ESI. Two of the 4 patients switched to long-term hemodialysis (HD) because of peritoneal failure. In group II, 8 patients (10.3%) responded to a combination of antibiotics and shaving of the external cuff. In group III, 21 patients (26.9%) with recurrent ESI underwent elective Tenckhoff catheter removal and reinsertion. One of the 21 patients had relapse of PSA ESI 14 months after the operation. In group IV, 14 patients (17.9%) had recurrent PSA ESI that failed to respond to multiple courses of antibiotics and shaving of the external cuff. Consent for Tenckhoff catheter removal was not obtained and 4 of these 14 patients subsequently developed PSA peritonitis. One of the 4 patients changed to permanent HD due to peritoneal failure. Conclusions Considering the increased risk and the poor outcome of PSA peritonitis in patients with persistent PSA ESI, early Tenckhoff catheter removal is recommended if the patient fails to respond to antibiotics with or without externalization of the external cuff.

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