bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preoperative Lipid Control with Simvastatin Reduces the Risk for Graft Failure Already 1 Year after Myocardial Revascularization
Authors: Christenson J.T. 
Published: September 2024

Hypercholesterolemia is a recognized risk factor for development of atherosclerosis in both native coronary arteries and bypass grafts. Lipid-lowering therapy with statins is effective. Few data are available for studies on bypass grafts. The influence of hypercholesterolemia on development of bypass graft disease was studied. Clinical and angiographic follow up 1 yr after CABG of patients with a preoperative cholesterol > 6.2 mmol/l, with a preoperative lipid control (group 2) or controls (group 1) and patients with cholesterol < 4.7 mmol/1 (group 3) were studied. Patient demographics, angiography and operation data were the same in all the groups. Group 1 patients had significantly higher incidence of graft lesions, requiring more interventions than Group 2. Sequential vein bypass grafts showed superior features compared to single vein grafts. Preoperative lipid control with statins is strongly recommended, since uncontrolled hypercholesterolemia has a direct impact on the outcome of CABG procedure. It significantly reduces the development of vein graft obstructive disease.
Initial Results of Ultrasound Screening for Aneurysm of the Abdominal Aorta in Western Australia: Relevance for Endoluminal Treatment of Aneurysm Disease
Authors: Lawrence-Brown Michael M.D. , Norman Paul E. , Jamrozik Konrad , Semmens James B. , Donnelly Neil J. , Spencer Carole , Tuohy Raywin 
Published: September 2024

Background. Increased life expectancy in men during the last thirty years is largely due to the decrease in mortality from cardiovascular disease in the age group 29–69 yr. This change has resulted in a change in the disease profile of the population with conditions such as aneurysm of the abdominal aorta (AAA) becoming more prevalent. The advent of endoluminal treatment for AAA has encouraged prophylactic intervention and fuelled the argument to screen for the disease. The feasibility of inserting an endoluminal graft is dependent on the morphology and growth characteristics of the aneurysm. This study used data from a randomized controlled trial of ultrasound screening for AAA in men aged 65–83 yr in Western Australia for the purpose of determining the norms of the living anatomy in the pressurized infrarenal aorta. Aims. To examine (1) the diameters of the infra-renal aorta in aneurysmal and non-aneurysmal cases, (2) the implications for treatment modalities, with particular reference to endoluminal grafting, which is most dependent on normal and aneurysmal morphology, and (3) any evidence to support the notion that northern Europeans are predisposed to aneurysmal disease. Methods. Using ultrasound, a randomized control trial was established in Western Australia to assess the value of a screening program in males aged 65–83 yr. The infra-renal aorta was defined as aneurysmal if the maximum diameter was 30 mm or more. Aortic diameter was modelled both as a continuous (in mm) and as a binary outcome variable, for those men who had an infra-renal diameter of 30 mm or more. ANOVA and linear regression were used for modelling aortic diameter as a continuum, while chi-square analysis and logistic regression were used in comparing men with and without the diagnosis of AAA. Findings. By December 1998. of 19,583 men had been invited to undergo ultrasound screening for AAA, 12,203 accepted the invitation (corrected response fraction 70.8%). The prevalence of AAA increased with age from 4.8% at 65 yr to 10.8% at 80 yr (χ2 = 77.9, df = 3, P<0.001). The median (IQR) diameter for the non-aneurysmal group was 21.4 mm (3.3 mm) and there was an increase (χ2 = 76.0, df = 1. P<0.001) in the diameter of the infra-renal aorta with age. Since 27 mm is the 95th centile for the non-aneurysmal infra-renal aorta, a diameter of 30 mm or more is justified as defining an aneurysm. The risk of AAA was higher in men of Australian (OR = 1.0) and northern European origin (OR = 1.0, 95%CL: 0.9. 1.2) compared with those of Mediterranean origin (OR = 0.5, 95%CL: 0.4. 0.7). Conclusion. Although screening has not yet been shown to reduce mortality from AAA, these population-based data assist the understanding of aneurysmal disease and the further development and use of endoluminal grafts for this condition.
Using Postoperative Cardiac Troponin-I (cTi) Levels to Detect Myocardial Ischaemia in Patients Undergoing Vascular Surgery
Authors: Andrews N. , Jenkins J. , Andrews G. , Walker P. 
Published: September 2024

Background. Cardiac complications occur commonly in vascular surgery patients. Diagnosis of cardiac complications is difficult because of the inaccuracies associated with traditional cardiac enzyme measurements. CTi. a highly sensitive and specific marker of myocardial injury, may be able to detect cardiac complications with greater ease and accuracy. Methods. The study prospectively examined 100 consecutive patients who underwent major vascular surgery between 6/7/98 and 31/12/98 at the Royal Brisbane Hospital. Daily measurements of cTi, creatine kinase (CK), creatine kinase MB (CKMB), CKMB index, renal function and haemoglobin were taken for three postoperative days. One postoperative electrocardiograph (ECG) was taken. An extensive cardiac history was taken. Intraoperative and postoperative events were recorded. Findings. There were 100 patients. 18 patients (18%) had a cTi elevation. On the basis of classical diagnostic criteria, 15 patients (15%) suffered one or more cardiac complication (either myocardial infarction, congestive cardiac failure, unstable angina or atrial fibrillation). One patient (1%) who had a cTi elevation died. CTi elevation occurred in five patients (5%) who were not diagnosed with cardiac complications based on traditional criteria. Despite not meeting specific diagnostic criteria for cardiac complications, all patients showed signs and symptoms that could be attributed to myocardial ischaemia. Every patient who developed congestive cardiac failure or atrial fibrillation had a cTi elevation. A Chi-square analysis revealed a significant association between cTi elevation and postoperative cardiac complications. Four variables contributed small but significant amounts of unique variance to the prediction of peak cTi on linear regression analysis. These were peak CKMB index, postoperative congestive cardiac failure, postoperative chest pain and postoperative cardiac complications. Conclusions. Routine cTi monitoring of postoperative vascular patients would be an effective and inexpensive way to detect patients with cardiac complications. The relationship between postoperative cTi elevation and significant coronary artery disease remains to be shown.
Surgical Repair of Anomalous Origin of the Coronary Artery from the Pulmonary Artery in Children
Authors: Malec Edward , Zając Andrzej , Mikuta Mirostaw 
Published: September 2024

Objective: To evaluate surgical management of children with coronary artery anomalies, including patients with rare abnormalities (left anterior descending artery or right coronary artery originating from the pulmonary artery). Methods: A retrospective review of eight patients (aged 2 months-10 yr; median 3.5 yr), treated for coronary artery anomalies between 1989 and 1999. Coronary vessels were reimplanted to the aorta in four children, while the remaining four were subjected to the Takeuchi procedure. Results: All children survived. None required mechanical circulatory support. In six patients significant mitral valve insufficiency developed, nevertheless, no intraoperative mitral valvuloplasty was performed. Follow-up was 2 months-10 yr. All patients developed normally and are currently in NYHA class I. Echocardiography revealed normal FS and EF values within 1–17 months postoperatively. Conclusions: In children with coronary artery anomalies, the best results are achieved with an early diagnosis and aggressive management. In our opinion coronary vessel reimplantation and the Takeuchi procedure yields comparable results.
Carotid Endarterectomy in Awake Patients with Contralateral Carotid Artery Occlusion
Authors: Karmeli R. , Lubezky N. , Halak M. , Loberman Z. , Weller B. , Fajer S. 
Published: September 2024

Objectives: Patients with severe stenosis of an internal carotid artery with contralateral occlusion (ICO) are at an increased risk for stroke, and therefore surgical treatment is usually recommended. Carotid endarterectomy (CEA) under regional anesthesia enables constant monitoring of neurologic status and selective shunting in cases of clinically evident cerebral ischemia. In this study, we assess the selective use of shunts based solely on changes in neurological status in awake patients with ICO undergoing CEA as well as their complication rates. Methods: During 1996–1998, we studied intraoperative findings and results of CEA under regional anesthesia with clinical monitoring of neurological status in two groups: (1) patients with stenosis (>70% by NASCET) and contralateral occlusion ( n = 50) and (2) patients with stenosis and no contralateral occlusion ( n = 94). Results: Shunt insertion was required in 42% of group 1, and 6% in group 2. All of the patients in group 1 requiring shunts had stump pressures <50 torr. The average stump pressure of group 1 (40 torr) was significantly lower than that of group 2 (75 torr), and was also lower than that of patients with severe contralateral stenosis (35 patients, 76 torr). Perioperative stroke rates were identical in both groups (2.1%). Conclusion: Since ICO patients are at a high risk for brain ischemia during ICA clamping, they require shunt insertion frequently. Patients with no contralateral occlusion require shunting at a much lower rate — even in the presence of severe contralateral stenosis. Regional anesthesia allows for early detection of brain ischemia and therefore, the perioperative results in both groups are similar.
Effect of Ischaemic Preconditioning, Cardiopulmonary Bypass and Myocardial Ischaemic/Reperfusion on Free Radical Generation in CABG Patients
Authors: Wu Zhong-Kai , Tarkka Matti R. , Eloranta Jussi , Pehkonen Erkki , Laurikka Jari , Kaukinen Liisa , Honkonen Eva L. , Vuolle Mikko , Kaukinen Seppo 
Published: September 2024

Objective: To investigate the free radicals (FR) generation after ischaemic preconditioning and cardiopulmonary bypass and during reperfusion in CABG patients, and the role of ischaemic preconditioning. Methods: Forty-three CABG patients were randomised into an ischaemic preconditioning and a control group. The protocol for ischaemic preconditioning was two cycles of 2-min ischaemia followed by 3-min reperfusion. Free radicals were measured using electron spin resonance spectroscopy. Global and right heart functions were collected. Results: The free radicals generation in coronary sinus blood in the ischaemic preconditioning group was 9.7 and 16.6% after the ischaemic preconditioning protocol and 10 min after declamping, 6.8 and 13.3% in the controls. The free radicals in arterial samples were, respectively, 21, 14, 10 and 9% at 10 min, 1, 2 and 24 h after reperfusion. Cardiac index (CI) and right ventricular ejection fraction (RVEF) were improved by ischaemic preconditioning. Conclusion: Both ischaemic preconditioning and cardiopulmonary bypass induced free radicals generation. Although ischaemic preconditioning had no effect on free radicals generation after the operation, it protected against postoperative stunning.
Tricuspid Regurgitation Secondary to Mitral Valve Disease: Tricuspid Annulus Function as Guide to Tricuspid Valve Repair
Authors: Colombo Tiziano , Russo Claudio , Ciliberto Guglielma Rita , Lanfranconi Marco , Bruschi Giuseppe , Agati Salvatore , Vitali Ettore 
Published: September 2024

Methods. A prospective analysis was performed on 50 patients (pts) with rheumatic mitral disease and associate secondary tricuspid insufficiency who underwent mitral valve replacement from January 1995 to December 1998. Surgical indication to tricuspid annuloplasty was considered in patients with echocardiographic tricuspid annulus diameter >21 mm/m2, regardless semiquantitative evaluation of tricuspid insufficiency. De Vega annuloplasty was performed in 33 out of 50 patients. Results. Hospital mortality was 2.0% (CL 0.3–3.6). The follow up of the discharged patients ranged from 3 to 48 months (mean 25±15.9). Three late deaths occurred (6.1% CL 2.8–9.2). Forty-two patients out of the 46 followed up (91.3% CL 84.9–93.8) were in I or II NYHA class. In eight patients (16.3% of discharged patients) the obtained result has been considered as ‘negative late results’: persisting moderate (three cases) or moderate-severe (five cases) Trl, together with congestive heart failure requiring a furosemide intake of >25 mg/day. No patients had severe Trl at follow up. The statistics analysis demonstrated the ‘preoperative fraction shortening of the tricuspid annulus’ ( P = 0.038) as factor predictive of late negative result. The incidence of late negative result was 57.1 % among patients with fractional shortening lower than 25% and 0% among those patients with fractional shortening greater than 25% ( P = 0.0001). Conclusions. The choice to treat the tricuspid insufficiency according to indexed tricuspid annulus dimension (>21 mm/m2) has been effective in terms of clinical efficacy and of late functional result. Fractional shortening of the tricuspid annulus, expression of right ventricular cardiomyopathy in patients with poorest prognosis, affects the postoperative evolution of tricuspid insufficiency.
Aortic Arch and Proximal Supraaortic Arterial Repair under Continuous Antegrade Cerebral Perfusion and Moderate Hypothermia
Authors: Jacobs Michael J. , de Mol Bas A. , Veldman Dirk J. 
Published: September 2024

Purpose: In this prospective study the clinical and neurological outcome of continuous antegrade cerebral perfusion (ACP) and moderate hypothermia was evaluated in patients undergoing ascending and aortic arch repair including reconstruction of the proximal supraaortic arteries. Methods: In 50 consecutive patients (mean age 47 yr, range 22–70) aortic arch and supraaortic arterial repair was performed: ascending aorta and aortic arch ( n = 34) and aortic arch and Bentall procedure ( n= 16). In 12 patients the distal anastomosis was performed using the elephant trunk technique. Test-clamping of the innominate artery for 3 min was performed under EEG-monitoring followed by the same procedure for the left carotid artery. Cardiopulmonary bypass was instituted and the innominate artery replaced by a polyester graft before antegrade perfusion was carried out through the graft. While cooling to 28–30°C, the left carotid artery was similarly treated with subsequent antegrade cerebral perfusion. The distal anastomosis was made at or beyond the left subclavian artery under circulatory arrest. During rewarming the innominate and carotid polyester grafts as well as the subclavian artery were anastomosed to the main graft, while antegrade cerebral perfusion was continued. Results: In 46 patients antegrade cerebral perfusion was achieved with a mean volume flow of 12 ml/kg/min and a mean arterial pressure of 54 mmHg. EEG-monitoring delineated stable and symmetrical recordings. In four patients antegrade flow (mean 15 ml/kg/min) and pressure (mean 65 mmHg) had to be increased to establish baseline EEG-recordings. The mean time of circulatory arrest was 18 min. The overall hospital mortality was 6%: two patients died from cerebral infarction and one patient suffered from a ruptured abdominal aortic aneurysm. Three patients (6%) developed a temporary neurological deficit which resolved spontaneously. Two patients (4%) developed renal failure requiring temporary hemodialysis. Pulmonary complications occurred in 12 patients (25%). Conclusion: Continuous antegrade cerebral perfusion via selective grafts to the innominate and carotid arteries offers adequate protection in patients undergoing replacement of the ascending aorta or aortic arch and great vessels. This technique allows radical repair and optimal vascular reconstruction without time restrains and avoids the necessity for profound hypothermia.
Aprotinin Reduces the IL-8 after Coronary Artery Bypass Grafting
Authors: Isbir C. Selim , Doǧan Riza , Demircin Metin , Yaylim Ilhan , Paşaoǧlu Ilhan 
Published: September 2024

The effect of aprotinin, a protease inhibitor, on myocardial interleukin-8 (IL-8) production after ischemia-reperfusion injury was investigated. Twenty patients who had elective coronary artery bypass grafting were included in this study. Patients were randomly divided into two groups ( n = 10 in each). Group A patients received high dose aprotinin (20,000 IU/kg as pretreatment followed by 7500 IU/kg for 6 h) and Group B patients received normal saline as a control. Serum IL-8 levels after the termination of cardiopulmonary bypass (CPB) showed a significant improvement in aprotinin treated group compared to control group (70±42.6 vs 360.71±87.9 ng/ml) ( P<0.005). Levels were also significantly higher at post-operative 24th hour in patients who did not received aprotinin (340.16±92.10 vs 96.13±34.33 ng/ml). However at post-operative 48th hour levels were again higher in control (untreated) group, but the difference was not statistically significant (78.8±34.4 vs 42.8±9.29 ng/ml). Aprotinin prevented the IL-8 release from myocytes in ischemia-reperfusion injury. The mechanism is highly dependent on anti-protease activity of aprotinin.
Endovascular AAA Repair in Patients with Renal Insufficiency: Strategies for Reducing Adverse Renal Events
Authors: Carpenter Jeffrey P. , Fairman Ronald M. , Barker Clyde F. , Golden Michael A. , Velazquez Omaida C. , Mitchell Marc E. , Baum Richard A. 
Published: September 2024

Vascular imaging, usually employing nephrotoxic contrast agents is relied upon for all aspects of endovascular AAA repair causing some to consider renal insufficiency a relative contraindication. We sought to determine if endovascular AAA evaluation and repair could be successfully accomplished by minimally or non-nephrotoxic modalities. Records and results for 98 consecutive patients undergoing endovascular AAA repair were reviewed. Patients requiring dialysis preoperatively were excluded ( N =3). The average volume of iodinated contrast agent employed for intraoperative imaging was 152 cc (35–420 cc). Twenty patients (20%) had baseline renal insufficiency (serum creatinine ≥1.3 mg/dl). A rise in serum creatinine above baseline was observed in 23 (24%) patients following repair: for 15 (16%) this was permanent. Creatinine rise occurred in patients with both normal (15) and abnormal (8) baseline values ( P=0.09). Rise in creatinine was independent of contrast volume employed and of the use of infrarenal vs suprarenal device fixation ( P>0.05). Two (2%) patients required permanent dialysis, one of which had a normal baseline creatinine and unclear etiology for renal failure, the other had a baseline creatinine of 2 and required device placement over an accessory renal artery. Strategies to minimize the use of nephrotoxic contrast for patients with renal insufficiency included the use of MRA, rather than contrast-CT for pre and postoperative imaging (7. 35%) and use of Gadolinium rather than iodinated contrast for performance of intraoperative arteriography (5. 25%). Endovascular grafts were successfully designed and implanted based upon MRA as the sole preoperative imaging modality in every case in which it was attempted (7). Mortality was not significantly different between those with and without abnormal baseline renal function ( P>0.05). Adverse events (access failures, arterial injuries, blood loss, endoleaks) were not significantly correlated with baseline renal insufficiency, rise in creatinine from baseline, use of MRA or intraoperative Gadolinium angiography ( P>0.05). Pre- and postoperative evaluation and performance of endovascular AAA repair can be accomplished in patients with renal insufficiency without increasing the rate of mortality or adverse events employing a strategy which minimizes the use of nephrotoxic contrast agents, relying upon Gadolinium arteriography and MRA. Endovascular grafts can be successfully planned and followed employing MRA as the sole imaging modality.
Beating Heart Myocardial Revascularization on Extracorporeal Circulation in Patients with End-Stage Coronary Artery Disease
Authors: Prifti Edvin , Bonacchi Massimo , Frati Giacomo , Giunti Gabriele , Proietti Piero , Leacche Marzia , Massetti Massimo , Babatasi Gerard , Sani Guido 
Published: September 2024

Objectives: To evaluate in a cohort of ESCAD patients (pts) the effects of on-pump/beating-heart versus conventional CABG in terms of early and mid-term survival and morbidity and LV function improvement. Methods: Between January 1993 and December 2000, 78 (Group I) ESCAD pts underwent on-pump/beating-heart surgery. Mean age in Group I was 66.2±6 (58–79), NYHA and CCS class were 3.2±0.6 and 3.3±0.4 respectively, Myocardial viability index 0.69±0.1 (%), LVEF (%) 24.8±4, LVEDP (mmHg) 28.1±5.8 and LVEDD(mm) 69.5±6. Group II consisted in 78 ESCAD patients undergoing conventional CABG selected in a randomized fashion from an age, sex, and LVEF corrected group of patients. Mean age in Group II was 65.7±5 (57–78). NYHA 3.1±0.7, CCS 3.4±0.8, LVEF(%) 25±5, LVEDP(mmHg) 27.9±4.4 and LVEDD(mm) 69.2±7.2. Results: Postoperatively, 5(7.7%) patients died in Group I versus 7(11.5%) patients in Group II ( P>0.1). CPB time resulted to be in Group II patients ( P=0.001) and the mean distal anastomoses per patient was similar between groups ( P=Ns). Perioperative AMI ( P=0.039), LCOS ( P= 0.002), necessity for ultrafiltration ( P=0.018) and bleeding>1000 ml ( P=0.029) were significantly higher in Group II. None of the Group I patients underwent surgical revision for bleeding versus 8(10.3%) patients in Group II ( P=0.011). At 6 months after surgery, the LV function improved significantly in Group I patients, demonstrated by an increased LVEF = 27.2±4(%)( P=0.001), lower LVEDP = 26.4±3(mmHg)( P=0.029) and LVEDD = 67±4(mm) ( P=0.004) instead of a lower LVEDD = 66.8±6(mm)( P=0.032) versus the preoperative data in Group II. The actuarial survival at 1, 3 and 5 yr were 90, 82 and 71% in Group I and 89, 83 and 74% in Group II ( P=Ns). Conclusion: In ESCAD patients who may poorly tolerate cardioplegic arrest, on-pump/beating-heart CABG may be an acceptable alternative associated with lower postoperative mortality and morbidity. Such a technique offers a better myocardial and renal protection associated with lower postoperative complications due to intraoperative hypoperfusion.
Female Sex Function after Aortic Surgery
Authors: Campbell W. B. , Ridler B. M. F. , McGrath C. 
Published: September 2024

Objective: To determine the incidence of sexual dysfunction in women after abdominal aortic surgery in a questionnaire based study Patients: A total of 100 women (aged 46–96, median 75 years) who had aortic grafts during 1990–1994. Methods: Patients were traced and their social circumstances determined. An initial approach was made by letter, and questionnaires were sent to women who were willing to participate at 1 year or more after their operation. Results: Sixty-nine patients were found to be ineligible because they had died (39), recently been widowed (15), become seriously unwell or untraceable (15). Of the remaining 31, only eight were willing to answer a detailed questionnaire about sexual function, and seven did so: four had maintained good sexual function, and three had experienced deterioration since surgery (but in two there had been some improvement over a period of months). Conclusions: Assessing any possible effect of aortic surgery on sexual function in women is most difficult, because of the age and circumstances of many patients, and a general reluctance of patients to answer explicit questions about their sexual function. Although this study fails to provide any clear evidence of adverse effects, it focuses attention on a neglected yet potentially important subject.