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Michael A Borger - One of the best experts on this subject based on the ideXlab platform.
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renal dysfunction in high risk patients after on pump and off pump coronary artery bypass surgery a propensity score analysis
The Annals of Thoracic Surgery, 2005Co-Authors: Andrew O Chukwuemeka, Ashley Weisel, Manjula Maganti, Franka A Nette, Duminda N Wijeysundera, William S Beattie, Michael A BorgerAbstract:BACKGROUND: Cardiopulmonary bypass may be a causal factor in the development of renal impairment after cardiac surgery. When acute renal failure requiring dialysis occurs after cardiac surgery, it is associated with high mortality. We attempted to determine whether off-pump coronary artery bypass Grafting surgery prevents postoperative renal dysfunction in patients at high risk for renal failure. METHODS: Retrospective analysis identified 2,869 patients who had preexisting renal dysfunction (preoperative creatinine clearance less than 60 mL/min) and who underwent isolated coronary artery bypass Grafting between 1995 and 2003. Patients who required preoperative dialysis were excluded. Propensity scores were computed to match off-pump coronary artery bypass surgery patients 3:1 with those who underwent conventional coronary artery bypass Grafting surgery, and the independent predictors of postoperative renal dysfunction were determined. RESULTS: Two thousand seven hundred eleven patients with preexisting renal dysfunction underwent conventional coronary artery bypass Grafting surgery, and 158 patients underwent coronary artery bypass Grafting surgery without cardiopulmonary bypass (off-pump coronary artery bypass Grafting surgery group). The matched groups showed no differences in any of the preoperative or postoperative variables examined. Diabetes (odds ratio, 1.96; p = 0.01), peripheral vascular disease (odds ratio, 2.50; p < 0.001), and reduced preoperative creatinine clearance (odds ratio, 1.02; p = 0.02) were independent risk factors for the development of postoperative renal dysfunction. Off-pump coronary artery bypass Grafting surgery was not associated with a decreased risk of renal dysfunction by univariate or multivariable analysis. CONCLUSIONS: Off-pump coronary artery bypass Grafting surgery did not reduce the risk of postoperative renal dysfunction in this large, unselected, sequential series of patients at high risk for renal failure after coronary artery bypass Grafting surgery. Our results suggest that renal function should not be a deciding factor when determining whether or not a patient undergoes off-pump coronary artery bypass Grafting surgery.
Bonnie H Sammons - One of the best experts on this subject based on the ideXlab platform.
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off pump coronary artery bypass Grafting provides complete revascularization with reduced myocardial injury transfusion requirements and length of stay a prospective randomized comparison of two hundred unselected patients undergoing off pump versus
The Journal of Thoracic and Cardiovascular Surgery, 2003Co-Authors: John D Puskas, Willis H Williams, Peggy G Duke, James R Staples, Kathryn E Glas, Jeffrey J Marshall, Mark E Leimbach, Philip R Huber, S Garas, Bonnie H SammonsAbstract:Abstract Objective: Retrospective comparisons of selected patients undergoing off-pump versus conventional on-pump coronary artery bypass Grafting have yielded inconsistent results and raised concerns about completeness of revascularization in off-pump coronary artery bypass Grafting. Methods: Two hundred unselected patients referred for elective primary coronary artery bypass Grafting were randomly assigned to undergo off-pump coronary artery bypass Grafting with an Octopus tissue stabilizer (Medtronic, Inc, Minneapolis, Minn) or conventional coronary artery bypass Grafting with cardiopulmonary bypass by a single surgeon. Revascularization intent determined before random assignment was compared with the revascularization performed. All management followed strict, unbiased, criteria-driven protocols. Patients and nonoperative care providers were blinded to surgical group. Results: Baseline characteristics were similar. The number of grafts performed per patient (mean ± SD 3.39 ± 1.04 for off-pump coronary artery bypass Grafting, 3.40 ± 1.08 for conventional coronary artery bypass Grafting) and the index of completeness of revascularization (number of grafts performed/number of grafts intended, 1.00 ± 0.18 for off-pump coronary artery bypass Grafting, 1.01 ± 0.09 for conventional coronary artery bypass Grafting) were similar. Likewise, the index of completeness of revascularization was similar between groups for the lateral wall. Combined hospital and 30-day mortalities and stroke rates were similar. Postoperative myocardial serum enzyme measures were significantly lower after off-pump coronary artery bypass Grafting, suggesting less myocardial injury. Adjusted postoperative thromboelastogram indices, fibrinogen, international normalized ratio, and platelet levels all showed significantly less coagulopathy after off-pump coronary artery bypass Grafting. Patients undergoing off-pump coronary artery bypass Grafting received fewer units of blood, were more likely to avoid transfusion altogether, and had a higher hematocrit at discharge. Cardiopulmonary bypass was an independent predictor of transfusion (odds ratio 2.42, P =.0073) by multivariate analysis. More patients undergoing off-pump coronary artery bypass Grafting were extubated in the operating room and within 4 hours. Postoperative length of stay (in days) was shorter for off-pump coronary artery bypass Grafting (5.1 ± 6.5 for off-pump coronary artery bypass Grafting, 6.1 ± 8.2 for conventional coronary artery bypass Grafting, P =.005 by Wilcoxon test). One patient (in the conventional coronary artery bypass Grafting group) required angioplasty for graft closure within 30 days. Conclusions: When compared with conventional coronary artery bypass Grafting with cardiopulmonary bypass, off-pump coronary artery bypass Grafting achieved similar completeness of revascularization, similar in-hospital and 30-day outcomes, shorter length of stay, reduced transfusion requirement, and less myocardial injury. J Thorac Cardiovasc Surg 2003;125:797-808
Yulin Deng - One of the best experts on this subject based on the ideXlab platform.
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The influence of Grafting chain length on the temperature response and separation performance of stationary phase with temperature response
2015 IEEE International Conference on Mechatronics and Automation (ICMA), 2015Co-Authors: Yanli Liang, Dandan Yang, Yulin DengAbstract:Three kinds of chromatography materials with temperature response have been prepared, and they were characterized by IR and TGA. By using the three materials, we studied the separation performance of four different steroids under 5 different temperatures. The results showed that bigger Grafting density would lead to shorter chain, lower temperature response and longer retention time. Thus, it is important for the preparation of stationary phase with temperature response ability to choose adaptive Grafting ratio, Grafting density and Grafting chain length.
Diederik Van Dijk - One of the best experts on this subject based on the ideXlab platform.
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cognitive outcomes 7 5 years after angioplasty compared with off pump coronary bypass surgery
The Annals of Thoracic Surgery, 2013Co-Authors: Annemette Sauer, Hendrik M Nathoe, Jeroen Hendrikse, Linda M Peelen, Jakub J Regieli, Dieuwke S Veldhuijzen, Cor J Kalkman, Diederick E Grobbee, Pieter A Doevendans, Diederik Van DijkAbstract:Background Off-pump coronary artery bypass Grafting and percutaneous coronary intervention are both associated with cognitive decline, but limited data are available on long-term outcomes. This study compared long-term cognitive outcomes between patients managed with percutaneous coronary intervention and off-pump coronary artery bypass Grafting. Methods A multicenter trial in the Netherlands randomized 280 patients to percutaneous coronary intervention or off-pump coronary artery bypass Grafting. Cognitive performance 7.5 years after randomization was assessed through a battery of 9 neuropsychologic tests and summarized into a combined Z-score. Results After 7.5 years, cognitive assessment could be performed in 81% of the 249 surviving patients. Better cognitive performance was observed in the off-pump coronary artery bypass Grafting group (combined Z-score 0.11 for off-pump coronary artery bypass Grafting versus -0.17 for percutaneous coronary intervention; difference 0.28, 95% confidence interval 0.08 to 0.47, p p = 0.08) after multivariable adjustment for potential confounders. Conclusions At 7.5 years follow-up, off-pump coronary artery bypass Grafting patients had a similar or perhaps even better cognitive performance compared with percutaneous coronary intervention patients.
Masaki Takeuchi - One of the best experts on this subject based on the ideXlab platform.
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novel application method of artificial dermis one step Grafting procedure of artificial dermis and skin rat experimental study
Burns, 2006Co-Authors: Kazutaka Soejima, Keijiro Hori, Motohiro Nozaki, Xin Chen, Hiroyuki Sakurai, Masaki TakeuchiAbstract:Abstract Background Currently, to treat skin defects with artificial dermis (AD), two surgical procedures where the artificial dermis Grafting and another secondary skin Grafting are required. The purpose of this study was to achieve simultaneous Grafting of the artificial dermis and the split-skin. To enhance the wound angiogenesis, cultured endothelial cells, fibroblasts and PDWHF (platelet derived wound healing factor) were employed. Methods The experiment consists of following two parts: (1) Investigation to obtain faster angiogenesis into the bilayer artificial dermis: full-thickness wounds created on the back of the rats were treated with the artificial dermis (Terudermis ® , with silicone sheet, TERUMO Co., Japan). Prior to the artificial dermis Grafting, following four groups were established; control group (AD alone, n = 6), PDWHF group (AD treated with PDWHF, n = 6), cultured cells group (AD treated with cultured endothelial cells and fibroblasts, n = 6), combination group (AD treated with PDWHF and cultured cells, n = 6). (2) Trial of one-stage Grafting of the AD and the skin: simultaneous Grafting of the artificial dermis and skin was performed using the same rat model. Before making skin defects, split thickness skin were harvested. Then the skin Grafting was carried out immediately after the AD Grafting. To allow Grafting of the skin onto the artificial dermis, the AD without silicone sheet (Terudermis ® without silicone sheet, TERUMO Co., Japan) were used. Two groups, control group (AD alone, n = 3) and treatment group (AD with PDWF and cultures, n = 3) were established. Results (1) When the artificial dermis were treated with PDWHF, cultured endothelial cells and fibroblasts, vascular invasion into the artificial dermis was observed 5 days after the surgery. (2) In the treatment group, the skin grafted immediately after the artificial dermis Grafting was completely taken. Conclusions The present study revealed that treatment with PDWHF, combined with cultured endothelial cells and fibroblasts, accelerated wound angiogenesis. By this method, one-step Grafting procedure of the artificial dermis and the skin is possible.
