Coronary bypass surgery

A broad-based cardiomyoplasty market should emerge by the late 1990s. Successhil development of a small-diameter graft to use in coronary bypass surgery instead of the patient s saphenous vein or mammary artery seems likely to occur by the year 2000. Development of appropriate materials and manufacturing methods are needed to maintain patency without damaging blood in grafts below 4 mm in diameter. 

The worldwide market for vascular grafts was approximately 150 million and growing at about 5% annuaUy as of 1995. The vascular graft area has tremendous market potential in development of smaU-diameter grafts of 3—4 mm for coronary bypass surgery. The total market for the intra-aortic baUoon pump, a cardiac-assist device, is ca 80 million worldwide. About 75,000 patients were supported by these baUoon pumps in 1994. This market is thought to have peaked. 

Nitroprusside is effective in the short-term management of severe HF in a variety of settings (e.g., acute MI, valvular regurgitation, after coronary bypass surgery, decompensated HF). Generally, it will not worsen, and may improve, the balance between myocardial oxygen demand and supply. However, an excessive decrease in systemic arterial pressure can decrease coronary perfusion and worsen ischemia. 

Risk factors for ARF include advanced age, acute infection, preexisting chronic respiratory or cardiovascular disease, dehydration, and chronic kidney disease (CKD). Decreased renal perfusion secondary to abdominal or coronary bypass surgery, acute blood loss in trauma, and uric acid nephropathy also increase risk. 

Valdecoxib (Bextra Pfizer), a second COX-2 specific inhibitor NSAID was taken off the market a few months after Vioxx. In addition to a higher risk of serious skin toxicity, pahents given Vioxx after Coronary Bypass Surgery had a higher rate of myocardial infarchons. 

Rahimtoola SH. A perspective on the three large multicenter randomized clinical trials of coronary bypass surgery for chronic stable angina. Circulation 1985 72 V123-V135... 

Serruys PW, Unger F, Sousa JE, et al. Comparison of coronary bypass surgery and stenting for the treatment of multivesel disease. N Engl J Med 2001 344 1117-1124. 

Rodriguez A, Baldi J, Pereira C, et al. Five-year followup of the argentine randomized trial of coronary angioplasty with stenting versus coronary bypass surgery in patients with multiple vessel disease. J Am Coll Cardiol 2005 46 583-588. 

Abrupt interruption of propranolol therapy in individuals with angina pectoris has been associated with reappearance of angina, acute myocardial infarction, or death due to a sudden increase in sympathetic nervous system tone to the heart. The mechanisms underlying these reactions are unknown, but they may be the result of an increase in the number of p-receptors that occur following chronic p-adrenoceptor blockade (up-regulation of receptors). When it is advisable to discontinue propranolol administration, such as before coronary bypass surgery, the dosage should be tapered over 2 to 3 days. 

Inclusion criteria were similar to our previous pilot study (34), Patients with clinical indication of percutaneous coronary revascularization were randomized if they had a de novo severe stenosis in a native coronary artery, a lesion suitable for stent, and a reference vessel size between 2.5 and 4.0 by visual estimation, and were a candidate for coronary bypass surgery, All the PCI procedures were performed at the Catheterization Laboratories at Otamendi Hospital and Sanatorio Las Lomas in Buenos Aires, Argentina. 

The Bypass Angioplasty Revascularization Investigation (BARI) Investigators. Comparison of coronary bypass surgery with angioplasty in patients with multivessel disease. N Engl J Med 1996 335(4) 2l7-225. 

Laham RJ, Sellke FW, Edelman ER, et al. Local perivascular delivery of basic fibroblast growth factor in patients undergoing coronary bypass surgery results of a phase I randomized, double-blind, placebo-controlled trial. Circulation 1999 ... 

RA was also shown to inhibit the production of series-2 prostaglandins and thromboxanes in endothelial cells from human saphenous vein, which is the vein commonly used in coronary bypass surgery (Urquhart et al., 2002). 

Women are more likely than men are to have a worse outcome after coronary bypass surgery. 

A 75-year-old man who had had coronary bypass surgery was given an intravenous infusion of adenosine for stress testing (25). After 1 minute he developed a three-beat run of wide-complex tachycardia, followed by a 20-second run of a regular wide-complex tachycardia at a rate of 115/minute. There was left bundle branch block, and the tachycardia ended spontaneously. Adenosine infusion was continued and some ventricular extra beats with the same configuration occurred. In this case there was impaired perfusion of the left ventricle. 

Detre K, Murphy ML, Hultgren H. Effect of coronary bypass surgery on longevity in high and low risk patients. Report from the V.A. Cooperative Coronary Snrgery Stndy. Lancet 1977 2(8051) 1243-5. 

Fortescue EB, Bates DW, and Chertow GM. 2000. Predicting acute renal failure after coronary bypass surgery cross-validation of two risk-stratification algorithms. KidneyInt 57 2594-2602. 

P. Szmagala, K. T. Gbure, N. Morawski, et al, A clinical assessment of ischemic preconditioning for aorto-coronary bypass surgery, Cor Europaeum 7, 107-111 (1999). 

Smith HC, Frey RL, Piehler JM. Does coronary bypass surgery have a favorable influence on the quality of life Cardiovasc Clin 1983 12 253-64,... 

Weintraub WS, Stein B, Kosinski A, et al. Outcome of coronary bypass surgery versus coronary angioplasty in diabetic patients with multivessel coronary artery disease. J Am Coll Cardiol 1998 31 10-19. 

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